Infective endocarditis presenting as inferior ST-elevation myocardial infarction.

Abstract

ST elevation myocardial infarction (STEMI) is an uncommon complication of infective endocarditis. We present a case of a 65-year-old male admitted with STEMI who was subsequently found to have a large aortic valve vegetation. The patient presented with angina and inferior STEMI complicated by ventricular fibrillation. Coronary angiography revealed acute distal posterior descending artery occlusion, with no discernible stenosis observed after wiring the vessel during the primary percutaneous intervention. This raised the suspicion of an embolic cause. Transthoracic echocardiography demonstrated a mobile mass attached to a bicuspid aortic valve. There were no symptoms or signs of infective endocarditis other than a 3-week history of fatigue.

Transoesophageal echocardiography confirmed a 0.7 cm mobile mass attached to the aortic valve. He underwent emergent aortic valve replacement with a bioprosthesis. Histological examination confirmed a vegetation though tissue and blood culture did not yield an organism. The patient was treated with 6 weeks of intravenous antibiotics and has recovered well.