An unusual case of infective endocarditis presenting as acute myocardial infarction

Abstract

A 39-year-old Zimbabwean man presented with a 1 week history of fever, general malaise and acute onset chest pain. He had a urethral stricture, which had been managed with an indwelling supra-pubic catheter. The electrocardiography on admission showed inferior ST-T segments elevation. His chest pain and electrocardiography changes resolved subsequent to thrombolysis, and he remained haemodynamically stable. The 12 h troponin I was increased at 10.5 µg/l (NR <0.04 µg/l). Echocardiography confirmed severe mitral regurgitation and a flail anterior mitral valve leaflet with an independently oscillating mobile vegetation. Enterococci faecalis were grown on blood cultures. A diagnosis of enterococci infective endocarditis with concomitant acute myocardial infarction due to possible septic emboli was made. Despite the successful outcome from thrombolysis in the setting of acute myocardial infarction with infective endocarditis, the case highlights the current lack of definitive data on the optimal acute management of such an unusual clinical scenario. Although there is serious concern that thrombolytic treatment for myocardial infarction in the setting of infective endocarditis may be associated with higher risk of cerebral haemorrhage, there is little documented evidence supporting the safety of primary percutaneous coronary intervention with these patients.

The usefulness of serum troponin levels to predict 1-year survival rates in infective endocarditis

“…Although the rate of enterococci infection was higher in troponin available group (12.5% vs. 2.8%) it was not statistically significant and we could not exclude the presence of selection bias in these patients. Another potential explanation of the increased troponin levels may be coronary embolism, which may be observed in the course of IE, although many cases may remain asymptomatic according to necropsy findings [15][16][17]. In our cohort, no patient presented with ischemic changes on electrocardiograms or had overt myocardial infarction.…”

The use of point‐of‐care ultrasound to diagnose infective endocarditis causing an NSTEMI in a patient with chest pain

“…On TTE, the classic ultrasonographic appearance of a vegetation is an irregularly shaped mobile structure that is typically located upstream of the valve . Sonographic findings of IE are dependent on the location of vegetation but can include evidence of pulmonary hypertension, premature mitral valve closure, evidence of diastolic dysfunction, and valvular regurgitation . Visualization of vegetation is diagnostic for IE.…”

An unusual presentation of an unusual disease: infective endocarditis: a case report and review of the literature

“…Other unusual presentations include presentation with meningitis [4], presentation with testicular swelling, pneumonia and septicemia in a teenager[5]. Acute myocardial Infarction [6], with Sweet's syndrome [7]. (Febrile neutrophilic dermatosis – skin condition in some cancer patients)…”