Infective endocarditis (IE) complicated with obstructive ST elevation myocardial infarction (STEMI) has been reported in the literature and which were mostly related to coronary artery embolism, obstruction, or compression. However, there has been no reported case discussing about IE complicated with nonobstructive STEMI.
In this report, we report a 38-year-old female suffering from intermittent fever and was later diagnosed as IE. Initially antibiotic was given and mitral valve surgery was also arranged due to large vegetation with severe mitral regurgitation. Nevertheless, sudden conscious loss with desaturation happened and brain computed tomography (CT) showed intracranial and subdural hemorrhage related to possible septic embolism. In addition, electrocardiography (ECG) revealed ST elevation over precordial leads, and elevation of cardiac enzymes was also noted.
Emergent coronary angiography was arranged but result showed normal coronary arteries without any evidence of stenosis. The diagnoses of IE complicated with nonobstructive STEMI were made.
After coronary angiography, the patient underwent craniotomy and subdural hematoma removal. Surprisingly, follow-up ECG also revealed ST segment resolution.
The patient received full course antibiotic treatment and follow-up brain CT also showed improvement of intracranial hemorrhage (ICH) and subdural hemorrhage. Because follow-up echocardiography still revealed severe mitral regurgitation with mitral valve prolapse due to leaflet destruction with partially decreased vegetation size, mitral valve replacement with bioprosthetic valve was performed and the patient was finally discharged smoothly.
In our knowledge, this case should be the 1st case of IE complicated with nonobstructive STEMI, which reminds physicians that nonobstructive STEMI is still an extremely rare but possible complication of IE and septic embolism related ICH should be carefully surveyed in this rare patient group.
aDivision of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
bDepartment of Internal Medicine
cGraduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Correspondence: Po-Chao Hsu, Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung 80708, Taiwan, ROC (e-mail: email@example.com).
Abbreviations: CT = computed tomography, ECG = electrocardiography, ICH = intracranial hemorrhage, IE = infective endocarditis, SDH = subdural hemorrhage, STEMI = ST elevation myocardial infarction.
The authors have no funding and conflicts of interest to disclose.
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Received July 5, 2018
Accepted October 11, 2018