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Lutsenko L, Sokolov M, Krychkevych V. A rare case report of fatal acute myocardial infarction as a complication of myocardial abscess. Eur Heart J Case Rep 2023; 7:ytad167. [PMID: 37090753 PMCID: PMC10118630 DOI: 10.1093/ehjcr/ytad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/09/2023] [Accepted: 04/03/2023] [Indexed: 04/25/2023]
Abstract
Background Myocardial abscess is a very rare life-threatening suppurative infection of the heart. Usually, myocardial abscess is a complication of infective endocarditis, and it is rarely associated with isolated myocardial infection. We present a case of an isolated myocardial abscess presenting with acute myocardial infarction. Case summary A 61-year-old man with a history of diabetes mellitus and coronary artery disease presented with a 3-h history of chest pain and inferior ST elevation. He had been treated for right-sided pneumonia 1.5 months prior to admission. Coronary angiography revealed acute occlusion of the posterolateral ventricular artery, and he underwent balloon angioplasty, which successfully restored TIMI-3 blood flow. Unfortunately, the patient went into cardiac arrest several hours later from which he could not be resuscitated. A post-mortem revealed a myocardial abscess in the inferior wall of the left ventricle. Discussion Myocardial abscess is a challenging diagnosis due to the speed of clinical deterioration and rarity. High clinical suspicion and urgent multimodality imaging may aid in the diagnosis.
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Affiliation(s)
- Lina Lutsenko
- Corresponding author. Tel: +380666669278, Fax: +380442756622,
| | - Maksym Sokolov
- Department of interventional cardiology, State Institution National Scientific Center The M.D. Strazhesko Institute of Cardiology, clinical and regenerative medicine of the National academy of medical sciences of Ukraine, Svyatoslava Horobrogo 5, 03151 Kyiv, Ukraine
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2
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Mazzoni C, Scheggi V, Marchionni N, Stefano P. ST-segment elevation myocardial infarction due to septic coronary embolism: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab302. [PMID: 34557633 PMCID: PMC8453402 DOI: 10.1093/ehjcr/ytab302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/07/2021] [Accepted: 07/13/2021] [Indexed: 12/05/2022]
Abstract
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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Affiliation(s)
- Carlotta Mazzoni
- Division of General Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, School of Human Health Sciences, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Valentina Scheggi
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,Division of Cardiovascular and Perioperative Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Niccolò Marchionni
- Division of General Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, School of Human Health Sciences, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Pierluigi Stefano
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134 Florence, Italy.,Division of Cardiac Surgery, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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3
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Abbasi D, Salehi N, Faiek S, Siddiqui WJ, Ahmad S. A Ghost in Coronary Artery - Coronary Artery Embolism After Discontinuation of Rivaroxaban in a Patient With Atrial Fibrillation: Case Report and Review of Literature. Cureus 2020; 12:e10082. [PMID: 33005506 PMCID: PMC7522164 DOI: 10.7759/cureus.10082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Coronary artery embolism (CAE) is a rare clinical entity that can cause acute myocardial infarction (AMI). The exact prevalence of coronary artery embolism is unknown. CAE was found to be associated with conditions that can lead to thrombo-embolism, including infective endocarditis, atrial fibrillation, mitral valve disease, valve surgery. Herein, we report a 78-year-old male with a past medical history of atrial fibrillation on rivaroxaban who presented to the hospital emergency department complaining of chest pain. The patient's anticoagulation therapy was recently held due to a concern for gastrointestinal bleeding. After further evaluation of the patient's symptoms and reviewing his electrocardiogram (ECG) which showed ST-depression in lateral leads and ST-elevation in aVR, urgent cardiac catheterization was done which showed left main coronary artery thrombosis extending into the left anterior descending artery (LAD) and left circumflex artery (LCX). The patient was started on a heparin drip and underwent a successful aspiration thrombectomy with subsequent improvement in his symptoms.
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Affiliation(s)
- Danish Abbasi
- Cardiovascular Diseases, University of Arkansas, Little Rock, USA
| | - Negar Salehi
- Internal Medicine - Cardiology, University of Arkansas, Little Rock, USA
| | - Saif Faiek
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | - Waqas J Siddiqui
- Cardiology/Nephrology, Drexel University College of Medicine, Philadelphia, USA.,Cardiology/Nephrology, Orange Park Medical Center, Orange Park, USA
| | - Shahzed Ahmad
- Cardiovascular Disease, Lower Bucks Hospital, Bristol, USA
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4
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Yesin M, Karakoyun S, Kalçık M, Gürsoy MO, Gündüz S, Astarcıoğlu MA, Bayam E, Cerşit S, Güner A, Özkan M. Status of the Epicardial Coronary Arteries in Non-ST Elevation Acute Coronary Syndrome in Patients with Mechanical Prosthetic Heart Valves (from the TROIA-ACS Trial). Am J Cardiol 2018; 122:638-644. [PMID: 29970239 DOI: 10.1016/j.amjcard.2018.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 11/18/2022]
Abstract
Coronary thromboembolism (CE) is a rare cause of prosthetic valve derived complications. This study investigates the diagnosis and treatment strategies for non-ST elevation acute coronary syndrome (NSTEACS) in patients with prosthetic heart valves. Forty-eight NSTEACS patients with prosthetic heart valves (mitral:27; aortic:14; mitral+aortic:7) were included in this study. All patients underwent transthoracic and transesophageal echocardiographic examination and coronary angiography. Normal coronary angiographic findings, or visible trombus in one of the coronary arteries, international normalized ratio <2, concomitant prosthetic valve thrombosis (PVT) and absence of multivessel atherosclerotic disease favored CE rather than atherothrombosis. Thrombolytic therapy (TT) with low-dose slow-infusion of tissue type plasminogen activator was used in patients with suspected CE and/or PVT. Coronary angiography demonstrated normal coronary arteries in 26 patients, CE in 16 patients and coronary atherosclerosis in 6 patients. Transesophageal echocardiography revealed obstructive PVT in 9 and nonobstructive PVT in 28 patients whereas 11 patients had normally functioning prostheses. TT was administered to 24 patients with PVT and/or CE. In these patients, TT was successful in 19 patients, partially successful in 4 patients and failed in 1 patient. In conclusion, NSTEACS in patients with prosthetic heart valves is more likely to be associated with PVT derived CE rather than atherosclerosis. TT with low-dose slow infusion of type plasminogen activator has proved its efficacy and safety in patients with CE and/or PVT.
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Affiliation(s)
- Mahmut Yesin
- Kars Harakani State Hospital, Department of Cardiology, Kars, Turkey.
| | - Süleyman Karakoyun
- Kafkas University Medical School, Department of Cardiology, Kars, Turkey
| | - Macit Kalçık
- Hitit University, Faculty of Medicine, Department of Cardiology, Çorum, Turkey
| | | | - Sabahattin Gündüz
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, İstanbul, Turkey
| | | | - Emrah Bayam
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, İstanbul, Turkey
| | - Sinan Cerşit
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, İstanbul, Turkey
| | - Ahmet Güner
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, İstanbul, Turkey
| | - Mehmet Özkan
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, İstanbul, Turkey; Ardahan University, Division of Health Sciences, Ardahan, Turkey
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5
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Jiao ZY, Zhang DP, Xia K, Wang LF, Yang XC. Clinical analysis of acute myocardial infarction caused by coronary embolism. J Thorac Dis 2017; 9:2898-2903. [PMID: 29221261 DOI: 10.21037/jtd.2017.07.92] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to investigate the clinical and angiographic features in patients with acute myocardial infarction (AMI) induced by coronary artery embolism. Methods Clinical data of five patients with AMI induced by coronary artery embolism were analyzed retrospectively. Results One patient had left atrial myxoma, one patient had non-valvular atrial fibrillation, and three patients had rheumatic heart disease. Furthermore, one patient had mitral mechanical valve prostheses, two patients had atrial fibrillation. Coronary angiography showed the absence of significant atherosclerostic lesions in the coronary arteries except infarct related artery in five patients. Angiography suggested the presence of IRA occlusion caused by embolism. Conclusions The status for AMI due to coronary artery embolism usually expresses embolic material originating from the left heart chambers. Rheumatic heart disease and atrial fibrillation are the common reasons for coronary artery embolism. Coronary artery occlusion is the common performance in the results of primary coronary artery angiography. Sometimes it expresses visible signs of embolism.
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Affiliation(s)
- Zhen-Yu Jiao
- The Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Da-Peng Zhang
- The Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Kun Xia
- The Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Le-Feng Wang
- The Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Xin-Chun Yang
- The Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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6
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Rencuzogullari I, Börekçi A, Karakoyun S, Cagdas M, Karabağ Y, Yesin M, Artac I, Ilis D. Coronary thrombosis in three coronary arteries due to whey protein. Am J Emerg Med 2016; 35:664.e3-664.e4. [PMID: 27839839 DOI: 10.1016/j.ajem.2016.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 11/01/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Abdurrezak Börekçi
- Kafkas University Medical School, Department of Cardiology, Kars, Turkey
| | - Süleyman Karakoyun
- Kafkas University Medical School, Department of Cardiology, Kars, Turkey
| | - Metin Cagdas
- Kafkas University Medical School, Department of Cardiology, Kars, Turkey
| | - Yavuz Karabağ
- Kafkas University Medical School, Department of Cardiology, Kars, Turkey
| | - Mahmut Yesin
- Department of Cardiology, Harakani State Hospital, Kars, Turkey
| | - Inanc Artac
- Kafkas University Medical School, Department of Cardiology, Kars, Turkey
| | - Dogan Ilis
- Kafkas University Medical School, Department of Cardiology, Kars, Turkey
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7
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Castelli JB, Almeida G, Siciliano RF. Sudden death in infective endocarditis. AUTOPSY AND CASE REPORTS 2016; 6:17-22. [PMID: 27818954 PMCID: PMC5087979 DOI: 10.4322/acr.2016.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/23/2016] [Indexed: 11/23/2022] Open
Abstract
The case fatality rate of infective endocarditis (IE) is high and is associated with varying causes. Among them, acute myocardial infarction due to an embolism in a coronary artery is rare; the incidence of this complication in the setting of IE is reported to be up to 1.5%. We report a case of sudden death in a 22-year-old woman diagnosed with systemic lupus erythematosus who was referred to the Cardiology Center for the treatment of mitral valve incompetence due to IE. She was hemodynamically stable with antibiotic therapy and vasoactive drugs, despite severe mitral valve regurgitation. Unexpectedly, she presented cardiac arrest and died. The autopsy showed total occlusion of the left main coronary artery by septic embolus, which originated from the mitral vegetation, as the cause of death. Thus, although a rare complication, it should always be kept in mind that a coronary embolism can be a lethal complication of IE, and the possibility of surgical treatment combined with the underlying antibiotic therapy should be raised.
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Affiliation(s)
- Jussara Bianchi Castelli
- Anatomic Pathology Department - Instituto do Coração - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Germana Almeida
- Internal Medicine Department - Instituto do Coração - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Rinaldo Focaccia Siciliano
- Infectious Disease Control Department - Instituto do Coração - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil
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8
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Bayar N, Kuş G, Küçükseymen S, Köklü E, Arslan Ş. A rare cause of myocardial infarction: Vegetation embolism. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2016. [DOI: 10.1016/j.ijcac.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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9
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Dual prosthetic heart valve presented with chest pain: a case report of coronary thromboembolism. Case Rep Cardiol 2015; 2015:895473. [PMID: 25785203 PMCID: PMC4345245 DOI: 10.1155/2015/895473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/01/2015] [Indexed: 11/18/2022] Open
Abstract
Coronary embolism from a prosthetic heart valve is a rare but remarkable cause of acute coronary syndrome. There is no definite management of an entity like this. Here we report a case of 54-year-old male with a history of rheumatic heart disease with dual prosthetic heart valve and atrial fibrillation who developed chest pain from acute myocardial infarction. The laboratory values showed inadequate anticoagulation. Cardiac catheterization and thrombectomy with the aspiration catheter were chosen to be the treatment for this patient, and it showed satisfactory outcome.
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10
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Patient with ST-elevation myocardial infarction, coronary artery embolism and no signs of coronary atherosclerosis in angiography. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:334-6. [PMID: 26677386 PMCID: PMC4679804 DOI: 10.5114/pwki.2015.55607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/11/2015] [Accepted: 03/23/2015] [Indexed: 11/17/2022] Open
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11
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Tang L, Hu XQ, Zhou SH. Coronary Artery Embolism Causing Acute Myocardial Infarction in Patients with Mechanical Heart Valve Prosthesis: Which is the Optimal Treatment? Heart Lung Circ 2014; 23:422-7. [DOI: 10.1016/j.hlc.2013.10.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
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12
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Alihanoglu YI, Kilic ID, Yildiz BS. Non-Atherosclerotic Causes of Acute Coronary Syndrome
and Management of The Patients. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2013. [DOI: 10.29333/ejgm/82300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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13
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Courand PY, Mouly-Bertin C, Thomson V, Lantelme P. Acute coronary syndrome revealed Cardiobacterium hominis endocarditis. J Cardiovasc Med (Hagerstown) 2012; 13:216-21. [PMID: 20838281 DOI: 10.2459/jcm.0b013e32833daf81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Evolution of acute coronary syndrome with normal coronary arteries and normal cardiac magnetic resonance imaging. Arch Cardiovasc Dis 2011; 104:509-17. [PMID: 22044703 DOI: 10.1016/j.acvd.2011.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/12/2011] [Accepted: 05/17/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) with normal coronary angiography is a frequent clinical situation with an uncertain prognosis. Cardiac magnetic resonance imaging (CMRI) is a powerful tool for differential diagnosis between myocardial infarction (MI), acute myocarditis and Tako-tsubo cardiomyopathy (TTC). Data are sparse regarding the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI. AIMS To evaluate the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI, with a 1-year follow-up. METHODS Eighty-seven consecutive patients (mean age, 53 years; 40.2% men) presenting an ACS with troponin elevation and normal coronary arteries by angiography were prospectively included. All patients underwent CMRI at 3-Tesla. Adverse events were recorded with 1-year follow-up. RESULTS A likely aetiology for the acute clinical presentation was established by CMRI in 63.2% of patients (22.7% MI, 26.4% acute myocarditis, 11.5% TTC). During follow-up, one patient in the MI group had a stroke (1.2%). In the myocarditis group, there was one initial cardiogenic shock, one episode of congestive heart failure (1.2%) and nine patients had recurrent chest pain without troponin elevation (10.3%). Two TTC group patients initially presented with cardiogenic shock (2.4%); there were no other adverse events in this group during follow-up. In the remaining 36.7% patients, no clear diagnosis could be identified by CMRI, and no adverse events occurred during follow-up. CONCLUSION CMRI is a useful tool for the management of ACS presenting with normal coronary angiography, as it helps to ascertain the diagnosis and adapt treatment in a large proportion of cases. Nonetheless, patients with no abnormalities identified by CMRI have an excellent evolution.
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15
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Luther V, Showkathali R, Gamma R. Chest pain with ST segment elevation in a patient with prosthetic aortic valve infective endocarditis: a case report. J Med Case Rep 2011; 5:408. [PMID: 21864374 PMCID: PMC3177923 DOI: 10.1186/1752-1947-5-408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 08/24/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Acute ST-segment elevation myocardial infarction secondary to atherosclerotic plaque rupture is a common medical emergency. This condition is effectively managed with percutaneous coronary intervention or thrombolysis. We report a rare case of acute myocardial infarction secondary to coronary embolisation of valvular vegetation in a patient with infective endocarditis, and we highlight how the management of this phenomenon may not be the same. CASE PRESENTATION A 73-year-old British Caucasian man with previous tissue aortic valve replacement was diagnosed with and treated for infective endocarditis of his native mitral valve. His condition deteriorated in hospital and repeat echocardiography revealed migration of vegetation to his aortic valve. Whilst waiting for surgery, our patient developed severe central crushing chest pain with associated anterior ST segment elevation on his electrocardiogram. Our patient had no history or risk factors for ischaemic heart disease. It was likely that coronary embolisation of part of the vegetation had occurred. Thrombolysis or percutaneous coronary intervention treatments were not performed in this setting and a plan was made for urgent surgical intervention. However, our patient deteriorated rapidly and unfortunately died. CONCLUSION Clinicians need to be aware that atherosclerotic plaque rupture is not the only cause of acute myocardial infarction. In the case of septic vegetation embolisation, case report evidence reveals that adopting the current strategies used in the treatment of myocardial infarction can be dangerous. Thrombolysis risks intra-cerebral hemorrhage from mycotic aneurysm rupture. Percutaneous coronary intervention risks coronary mycotic aneurysm formation, stent infections as well as distal septic embolisation. As yet, there remains no defined treatment modality and we feel all cases should be referred to specialist cardiac centers to consider how best to proceed.
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Affiliation(s)
- Vishal Luther
- Department of Medicine, Whittington Hospital NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Refai Showkathali
- Department of Cardiology, The Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex, UK, SS16 5NL, UK
| | - Reto Gamma
- Department of Cardiology, The Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex, UK, SS16 5NL, UK
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Acute Myocardial Infarction due to Coronary Artery Embolism in a Patient with Mechanical Aortic Valve Prosthesis. Case Rep Med 2010; 2010:751857. [PMID: 20592990 PMCID: PMC2892696 DOI: 10.1155/2010/751857] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Revised: 03/28/2010] [Accepted: 05/04/2010] [Indexed: 11/26/2022] Open
Abstract
Previous cases of coronary embolism as a cause of myocardial infarction (MI) in association with prosthetic mechanical valves have been reported, but the fact that the patient was not aware of the importance of maintaining anticoagulation therapy is relevant in this case. A 16-year-old female was referred for primary coronary intervention due to subacute anterolateral ST elevation MI, after she decided to discontinue warfarin therapy three weeks before. Coronary angiography showed distal occlusion of the left anterior descending coronary artery with an image suggesting embolic material. Conventional echocardiography demonstrated akinesia of anteroseptal, inferior, and posterior segments of the left ventricle, with severe systolic dysfunction, beyond the intraventricular thrombus. The presence of mechanic aortic prosthesis and no anticoagulation therapy are highly suggestive of coronary embolism as the cause of MI. This case report confirms that patient education is vital in our struggle to prevent this complication in high-risk patients.
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17
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Kardasz I, De Caterina R. Myocardial infarction with normal coronary arteries: a conundrum with multiple aetiologies and variable prognosis: an update. J Intern Med 2007; 261:330-48. [PMID: 17391108 DOI: 10.1111/j.1365-2796.2007.01788.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The existence of myocardial infarction despite angiographically normal coronary arteries was recognized more than 30 years ago. Since then, various series of such patients have been described, but the aetiology and pathogenesis of the condition are still a source of debate. Evidence exists for a role of coronary vasospasm, thrombosis, embolization and inflammation, per se or combined, in determining the occurrence of myocardial infarction in the presence of angiographically normal coronary arteries. Endothelial dysfunction, possibly superimposed to nonangiographically evident atherosclerosis, may be an underlying common feature predisposing to the acute event. Additionally, myocarditis may explain some of these occurrences. Myocardial infarction with normal coronary arteries is therefore likely the result of multiple pathogenetic mechanisms. Although most reports emphasize the good prognosis of this condition, in general much better than myocardial infarction with coronary artery disease, prognosis is likely variable according to the underlying mechanism. This review summarizes current knowledge on this condition and examines areas of recent progress.
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Affiliation(s)
- I Kardasz
- Institute of Cardiology and Center of Excellence on Aging, G. d'Annunzio University - Chieti, Chieti, and CNR Institute of Clinical Physiology, Pisa, Italy
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18
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Khan F, Khakoo R, Failinger C. Managing embolic myocardial infarction in infective endocarditis: current options. J Infect 2005; 51:e101-5. [PMID: 16230184 DOI: 10.1016/j.jinf.2004.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Accepted: 10/11/2004] [Indexed: 11/21/2022]
Abstract
Systemic embolization is common in infective endocarditis and is known to occur in 45-65% of cases. Coronary artery embolism has been seen in as many as 60% of cases at necropsy. However, it only rarely has been described as resulting in transmural myocardial infarction. In most cases, coronary embolism is inferred from circumstantial evidence. We present two patients with myocardial infarction in the setting of acute infective endocarditis. Current issues regarding the management of myocardial infarction in infective endocarditis are described in this article. We also describe the first documented case of Lactobacillus jensenii endocarditis leading to myocardial infarction. Possible factors, which may be instrumental in producing endocarditis with this organism, are also discussed.
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Affiliation(s)
- Fida Khan
- Department of Internal Medicine, Section of Infectious Diseases, West Virginia University Hospitals, Morgantown, West Virginia, USA.
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19
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Kosar F, Gullu H, Sahin I, Acikgoz N, Topal E, Erdil N. A case of vasospastic angina resulting from coronary emboli in a patient with prosthetic valves. JAPANESE HEART JOURNAL 2004; 45:325-30. [PMID: 15090709 DOI: 10.1536/jhj.45.325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In addition to coronary atherosclerotic disease, coronary thromboembolism can also lead to acute coronary syndromes. However, coronary thromboembolism due to prosthetic heart valves is very rare and not very well-known. It have been reported only a few cases. In this paper, we present a rare case with vasospastic angina pectoris secondary to coronary thromboembolism in a patient with prosthetic heart valves.
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Affiliation(s)
- Feridun Kosar
- Department of Cardiology, Faculty of Medicine, Inonu University, Turgut Oza Medical Center, Malatya, Turkey
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Aslam MS, Sanghi V, Hersh S, Lakier JB. Coronary artery saddle embolus and myocardial infarction in a patient with prosthetic mitral valve. Catheter Cardiovasc Interv 2002; 57:367-70. [PMID: 12410516 DOI: 10.1002/ccd.10316] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coronary embolism is a rare cause of transmural myocardial infarction. A 58-year old female with mechanical mitral valve prosthesis and chronic atrial fibrillation who presented with anterolateral myocardial infraction is described. The etiologies, diagnosis, treatment dilemma and various management options are discussed.
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Molpus JL, Nadkarni M. Massive embolic myocardial infarction in a teenager. Pediatr Emerg Care 2002; 18:101-4. [PMID: 11973503 DOI: 10.1097/00006565-200204000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J Lane Molpus
- Department of Emergency Medicine, North Carolina Baptist Hospital, Winston-Salem, North Carolina 27157, USA.
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 31-1992. A 68-year-old man with acute mitral regurgitation. N Engl J Med 1992; 327:338-45. [PMID: 1620173 DOI: 10.1056/nejm199207303270507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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