Nonbacterial Thrombotic Endocarditis Leading to Acute Heart Failure due to Aortic Stenosis in a Patient with Lung Cancer

Abstract

We herein report an autopsied case of a patient with adenocarcinoma of the lungs who developed nonbacterial thrombotic endocarditis (NBTE) that caused acute heart failure (AHF) due to acute aortic stenosis (AS). A 37-year-old man was admitted to our hospital due to chest pain and fever. He was diagnosed as having Stage IV lung cancer. Following the administration of chemotherapy, the patient presented with acute onset of dyspnea. He was diagnosed with having AHF based on his clinical course and physical findings, and ultimately he died without responding to treatment. The autopsy revealed that NBTE caused acute AS leading to AHF.

Nonbacterial Thrombotic Endocarditis with Bivalvular Regurgitation

“… 6 The symptoms of valvular dysfunction are seldom observed, with scarce case reports of cardiac failure resulting from aortic or tricuspid regurgitation in patients with NBTE. 7 In this case of NBTE the patient’s native valve integrity was compromised, leading to not only bivalvular involvement but also bivalvular regurgitation. In a previously described case of NBTE with valvular regurgitation, treatment with anticoagulation led to resolution of the valvular dysfunction.…”

Multiple Hypercoagulability Disorders at Presentation of Non-Small-Cell Lung Cancer

“…Association of venous thrombosis, such as DVT and PE, in cancer patients has been well established and can have an adverse effect on survival11,14. However, in general, NBTE and its embolization to coronary and/or cerebral arteries have not been well evaluated; most were reported after the diagnosis of cancer7,10. With our limited knowledge, this case shows a unique clinical presentation of DVT, NBTE, recurrent cerebral embolic infarction, and heart failure at the time of diagnosis of lung cancer.…”

“…Systemic embolization to the central nervous system and coronary arteries are often observed in NBTE patients8,9. However, acute heart failure caused by NBTE with cardiac valve lesions is a rare clinical event10.…”