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ST-segment elevation myocardial infarction due to septic coronary embolism: a case report

BACKGROUND : Coronary artery embolism is an infrequent cause of type 2 myocardial infarction which can be due to arterial thromboembolism or septic embolism. While systemic embolization is one of the most acknowledged and threatened complications of infective endocarditis, coronary localization of t...

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Autores principales: Mazzoni, Carlotta, Scheggi, Valentina, Marchionni, Niccolò, Stefano, Pierluigi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453402/
https://www.ncbi.nlm.nih.gov/pubmed/34557633
http://dx.doi.org/10.1093/ehjcr/ytab302
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author Mazzoni, Carlotta
Scheggi, Valentina
Marchionni, Niccolò
Stefano, Pierluigi
author_facet Mazzoni, Carlotta
Scheggi, Valentina
Marchionni, Niccolò
Stefano, Pierluigi
author_sort Mazzoni, Carlotta
collection PubMed
description BACKGROUND : Coronary artery embolism is an infrequent cause of type 2 myocardial infarction which can be due to arterial thromboembolism or septic embolism. While systemic embolization is one of the most acknowledged and threatened complications of infective endocarditis, coronary localization of the emboli causing acute myocardial infarction is exceedingly rare occurring in <1% of cases. CASE SUMMARY : A 52-year-old man with a history of Bentall procedure and redo aortic valve replacement due to prosthetic degeneration (11 years prior to the current presentation) presented to the emergency department with high-grade fever and myalgias. Shortly after his arrival, he experienced typical chest pain and an electrocardiogram demonstrated signs of inferior ST-elevation myocardial infarction: coronary angiography showed a lesion of presumed embolic origin at the level of the mid-distal circumflex coronary artery which was treated with embolectomy. Transthoracic and transoesophageal echocardiography highlighted the presence of a periaortic abscess. The final diagnosis of infective endocarditis as the cause of septic coronary artery embolization was confirmed with a Positron Emission Tomography-Computed Tomography (PET-CT) exam and by the growth of Staphylococcus lugdunensis on repeated blood cultures. The patient underwent successful redo Bentall surgery the good outcome was confirmed at 1-month follow-up. DISCUSSION : Type 2 myocardial infarction caused by coronary embolism is a rare presentation of infective endocarditis and requires a high level of suspicion for its diagnosis. Prosthetic heart valves are a predisposing factor for infective endocarditis: aortic root abscess requires surgery as it rarely regresses with antibiotic therapy.
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spelling pubmed-84534022021-09-22 ST-segment elevation myocardial infarction due to septic coronary embolism: a case report Mazzoni, Carlotta Scheggi, Valentina Marchionni, Niccolò Stefano, Pierluigi Eur Heart J Case Rep Case Report BACKGROUND : Coronary artery embolism is an infrequent cause of type 2 myocardial infarction which can be due to arterial thromboembolism or septic embolism. While systemic embolization is one of the most acknowledged and threatened complications of infective endocarditis, coronary localization of the emboli causing acute myocardial infarction is exceedingly rare occurring in <1% of cases. CASE SUMMARY : A 52-year-old man with a history of Bentall procedure and redo aortic valve replacement due to prosthetic degeneration (11 years prior to the current presentation) presented to the emergency department with high-grade fever and myalgias. Shortly after his arrival, he experienced typical chest pain and an electrocardiogram demonstrated signs of inferior ST-elevation myocardial infarction: coronary angiography showed a lesion of presumed embolic origin at the level of the mid-distal circumflex coronary artery which was treated with embolectomy. Transthoracic and transoesophageal echocardiography highlighted the presence of a periaortic abscess. The final diagnosis of infective endocarditis as the cause of septic coronary artery embolization was confirmed with a Positron Emission Tomography-Computed Tomography (PET-CT) exam and by the growth of Staphylococcus lugdunensis on repeated blood cultures. The patient underwent successful redo Bentall surgery the good outcome was confirmed at 1-month follow-up. DISCUSSION : Type 2 myocardial infarction caused by coronary embolism is a rare presentation of infective endocarditis and requires a high level of suspicion for its diagnosis. Prosthetic heart valves are a predisposing factor for infective endocarditis: aortic root abscess requires surgery as it rarely regresses with antibiotic therapy. Oxford University Press 2021-07-29 /pmc/articles/PMC8453402/ /pubmed/34557633 http://dx.doi.org/10.1093/ehjcr/ytab302 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Report
Mazzoni, Carlotta
Scheggi, Valentina
Marchionni, Niccolò
Stefano, Pierluigi
ST-segment elevation myocardial infarction due to septic coronary embolism: a case report
title ST-segment elevation myocardial infarction due to septic coronary embolism: a case report
title_full ST-segment elevation myocardial infarction due to septic coronary embolism: a case report
title_fullStr ST-segment elevation myocardial infarction due to septic coronary embolism: a case report
title_full_unstemmed ST-segment elevation myocardial infarction due to septic coronary embolism: a case report
title_short ST-segment elevation myocardial infarction due to septic coronary embolism: a case report
title_sort st-segment elevation myocardial infarction due to septic coronary embolism: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453402/
https://www.ncbi.nlm.nih.gov/pubmed/34557633
http://dx.doi.org/10.1093/ehjcr/ytab302
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