Septic embolization of left and right coronary arteries resulting in sudden death: A rare complication of infective endocarditis

Abstract

a b s t r a c tBacterial endocarditis gives rise to a variety of complications due to local tissue damage, immunological phenomena, and embolic phenomena. Only a small number of cases of coronary embolization have been reported in infective endocarditis patients. This is a case of subacute bacterial endocarditis in a postpartum mother complicated by fatal left and right coronary artery embolization. A 32-year-old postpartum mother with a history of rheumatic heart disease presented with a history of fever, shortness of breath, and bilateral ankle edema for 1-week duration. On admission, the patient was alert, febrile with a pulse rate of 90 beats/min, blood pressure 105/70 mmHg, and her lungs were clear. Transthoracic echocardiography revealed vegetations attached to both mitral and aortic valves. She was started on intravenous antibiotics. Her fever was settled and during the following 2 weeks she was clinically improving with settling inflammatory markers. On the 20th day of the illness, the patient developed sudden onset of chest pain, dyspnea with sinus bradycardia, and later developed pulseless electric activity. She expired despite intense cardiopulmonary resuscitation. Postmortem revealed multiple vegetations in both mitral and aortic valves and complete occlusion of both left and right coronary ostia by embolized vegetative materials. <Learning objective: Subacute bacterial endocarditis with large and mobile vegetations can give rise to embolization. Although most of them cause peripheral embolization, there is a possibility of fatal coronary embolization. This case highlights the importance of early surgical intervention in bacterial endocarditis with large, multiple, and mobile vegetations even though the patient is responding to the antibiotics.>

Postpartum Endocarditis and Left Main Embolization

“…Early post-partum infective endocarditis (IE) is rare, with the typical population being individuals with a history of intravenous drug use and patients with a structurally abnormal heart (1)(2)(3). IE exerts its deleterious effects via local tissue damage, immunologic response, and embolic events, particularly to the cerebral arteries (4). Although uncommon, septic emboli to the coronary arteries can cause myocardial infarction, and sudden death (3)(4)(5).…”

“… 1 , 2 , 3 IE exerts its deleterious effects via local tissue damage, immunologic response, and embolic events, particularly affecting the cerebral arteries. 4 Although uncommon, septic emboli to the coronary arteries can cause myocardial infarction, and sudden death. 3 , 4 , 5 Many different strategies for the management of coronary embolism have been reported, including antithrombotic therapy, thrombectomy, percutaneous coronary intervention (PCI), and surgical embolectomy.…”

“… 4 Although uncommon, septic emboli to the coronary arteries can cause myocardial infarction, and sudden death. 3 , 4 , 5 Many different strategies for the management of coronary embolism have been reported, including antithrombotic therapy, thrombectomy, percutaneous coronary intervention (PCI), and surgical embolectomy. 5 Here, we present a case of postpartum IE, with a rare acute coronary syndrome presentation due to the presence of a left main coronary artery embolization.…”