Acute Myocardial Infarction Due to Septic Coronary Embolism

Fatal Embolic Myocardial Infarction after Systemic Thrombolysis for Stroke

“…Hitherto, coronary embolism has been observed in patients with atrial myxoma [10] , aortic valve endocarditis [11] , a preexisting left ventricular thrombus in dilated cardiomyopathy [12] , atrial septal defects and cardiac surgery [13] . Moreover, a possible relationship between thrombolytic therapy and coronary embolism has been suggested [14] , but there has been no such report in conjunction with systemic thrombolysis for stroke.…”

Thrombolytic therapy for acute myocardial infarction in unsuspected infective endocarditis

“…D Although coronary embolism of fragments of vegetations is not an uncommon finding in autopsy studies of infective endocarditis [1], clinically apparent acute myocardial infarction (AMI) is rarely observed [2]. The contradictory experimental studies [3,4] and the extremely uncommon clinical cases of thrombolytic therapy in the setting of AMI complicating endocarditis preclude a systematic assessment of this therapy [5][6][7][8][9]. We present a patient with unsuspected infective endocarditis who developed an episode of chills and fever shortly after thrombolytic therapy for AMI.…”

“…Thrombolytic therapy in human with endocarditis-associated AMI is very uncommon. In 1991, Herzog et al [5] described the first patient with endocarditis-associated AMI treated with thrombolytic therapy, and since then only four additional cases have been reported (Table 1) [6][7][8][9].…”

“…However, the episode of chills, flushing and fever after thrombolytic administration suggested bacteraemia secondary to partial vegetation digestion. Four out of five reported patients with endocarditis-associated AMI had prodromal fever prior thrombolytic administration [6][7][8][9]. In such circumstances, an early binfectiveQ myocardial infarction due to systemic febrile illness (including infective endocarditis), acute myopericarditis, and coronary artery vasculitis should be suspected [6,13].…”

“…In all five reported patients who had received thrombolytic agents for AMI-associated endocarditis developed severe bleeding complications [5][6][7][8][9], including four patients with intracranial haemorrhages (80%) [5,6,8,9], and one with major haematemesis [7]. Three patients died [6,8,9], two of intracraneal haemorrhage [6,9] and other of cardiogenic shock or cerebellar haemorrhage [8]. The increased risk of fatal intracranial bleeding, probably secondary to rupture of intracranial mycotic aneurysm, does not require the administration of thrombolytic agents in these patients with AMI-associated endocarditis.…”