“Snake” Shaped Vegetation in Right Coronary Artery

Infective endocarditis is a rare cause of coronary embolism. This can result in myocardial infarction. Prompt identification is necessary as management is different from a regular myocardial infarction. Unlike in regular myocardial infarction, use of thrombolytics in this scenario could result in life-threatening complications and hence not indicated. In a patient who appears to be septic, embolic myocardial infarction should always be in the working differential diagnosis. An early transesophageal echocardiogram and cardiac catheterization could assist in diagnosis and management. We present an interesting case of a 45-year-old man who was admitted with vision loss, fevers and was found to have a non-ST segment elevation myocardial infarction. He had persistent bacteremia and developed systemic emboli. Investigation revealed mitral valve vegetation and a cardiac catheterization showed an interesting “snake”-shaped embolic vegetation in right coronary artery. He was treated with surgery to the mitral valve and antibiotics. In a septic patient with myocardial infarction, possibility of coronary embolism from vegetation should be kept in mind.