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ST segment elevation caused by ostial right coronary artery obstruction in infective endocarditis: a case report

BACKGROUND: Acute coronary syndrome (ACS) is a rare, but serious complication of infective endocarditis, and diagnosis can be challenging given clinical overlap with other syndromes. A rare cause of ACS in infective endocarditis is mechanical obstruction of the coronary artery. We present the case o...

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Autores principales: Bolton, Alexander, Hajj, Georges, Payvandi, Laila, Komanapalli, Christopher
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488518/
https://www.ncbi.nlm.nih.gov/pubmed/32917139
http://dx.doi.org/10.1186/s12872-020-01672-1
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author Bolton, Alexander
Hajj, Georges
Payvandi, Laila
Komanapalli, Christopher
author_facet Bolton, Alexander
Hajj, Georges
Payvandi, Laila
Komanapalli, Christopher
author_sort Bolton, Alexander
collection PubMed
description BACKGROUND: Acute coronary syndrome (ACS) is a rare, but serious complication of infective endocarditis, and diagnosis can be challenging given clinical overlap with other syndromes. A rare cause of ACS in infective endocarditis is mechanical obstruction of the coronary artery. We present the case of a patient with infective endocarditis who developed ST segment myocardial infarction due to occlusion of the right coronary artery ostium by a vegetation. CASE PRESENTATION: A 53-year-old female with no prior history of coronary artery disease was transferred to our tertiary care facility for evaluation and treatment of suspected myopericarditis. After transfer she developed inferior ST segment elevations on ECG along with fever and positive blood cultures for methicillin susceptible Staphylococcus aureus (MSSA). A transesophageal echocardiogram revealed a vegetation on the aortic valve that intermittently prolapsed into the right coronary ostium. She decompensated from a hemorrhagic brain infarct and subsequently transferred to the intensive care unit. She underwent surgical aortic valve debridement without prior cardiac catheterization given the danger of septic coronary embolization. After a prolonged hospital course with multiple complications, she was able to discharge home, with no neurologic deficits on follow-up. CONCLUSIONS: ACS presents a diagnostic and therapeutic challenge in the setting of infective endocarditis. Careful attention to the history, physical exam and testing can help differentiate infective endocarditis from other conditions sharing similar symptoms. Traditional atherosclerotic ACS management may cause great harm when treating patients with infective endocarditis. The presence of a multidisciplinary endocarditis team is ideal to provide the best clinical outcomes for this population.
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spelling pubmed-74885182020-09-16 ST segment elevation caused by ostial right coronary artery obstruction in infective endocarditis: a case report Bolton, Alexander Hajj, Georges Payvandi, Laila Komanapalli, Christopher BMC Cardiovasc Disord Case Report BACKGROUND: Acute coronary syndrome (ACS) is a rare, but serious complication of infective endocarditis, and diagnosis can be challenging given clinical overlap with other syndromes. A rare cause of ACS in infective endocarditis is mechanical obstruction of the coronary artery. We present the case of a patient with infective endocarditis who developed ST segment myocardial infarction due to occlusion of the right coronary artery ostium by a vegetation. CASE PRESENTATION: A 53-year-old female with no prior history of coronary artery disease was transferred to our tertiary care facility for evaluation and treatment of suspected myopericarditis. After transfer she developed inferior ST segment elevations on ECG along with fever and positive blood cultures for methicillin susceptible Staphylococcus aureus (MSSA). A transesophageal echocardiogram revealed a vegetation on the aortic valve that intermittently prolapsed into the right coronary ostium. She decompensated from a hemorrhagic brain infarct and subsequently transferred to the intensive care unit. She underwent surgical aortic valve debridement without prior cardiac catheterization given the danger of septic coronary embolization. After a prolonged hospital course with multiple complications, she was able to discharge home, with no neurologic deficits on follow-up. CONCLUSIONS: ACS presents a diagnostic and therapeutic challenge in the setting of infective endocarditis. Careful attention to the history, physical exam and testing can help differentiate infective endocarditis from other conditions sharing similar symptoms. Traditional atherosclerotic ACS management may cause great harm when treating patients with infective endocarditis. The presence of a multidisciplinary endocarditis team is ideal to provide the best clinical outcomes for this population. BioMed Central 2020-09-11 /pmc/articles/PMC7488518/ /pubmed/32917139 http://dx.doi.org/10.1186/s12872-020-01672-1 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Bolton, Alexander
Hajj, Georges
Payvandi, Laila
Komanapalli, Christopher
ST segment elevation caused by ostial right coronary artery obstruction in infective endocarditis: a case report
title ST segment elevation caused by ostial right coronary artery obstruction in infective endocarditis: a case report
title_full ST segment elevation caused by ostial right coronary artery obstruction in infective endocarditis: a case report
title_fullStr ST segment elevation caused by ostial right coronary artery obstruction in infective endocarditis: a case report
title_full_unstemmed ST segment elevation caused by ostial right coronary artery obstruction in infective endocarditis: a case report
title_short ST segment elevation caused by ostial right coronary artery obstruction in infective endocarditis: a case report
title_sort st segment elevation caused by ostial right coronary artery obstruction in infective endocarditis: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488518/
https://www.ncbi.nlm.nih.gov/pubmed/32917139
http://dx.doi.org/10.1186/s12872-020-01672-1
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