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      Acute myocardial infarction and concomitant ischemic stroke as an unusual presentation of native mitral valve endocarditis

      case-report

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          Abstract

          ST-elevation myocardial infarction (STEMI) due to septic coronary embolism is a rare complication of infective endocarditis (IE) and is associated with high mortality rates. When common signs of IE are often overlooked on admission, the diagnosis may be established through complications, which may cause prominent symptoms. Here, we report a case of native mitral valve endocarditis with an unusual presentation with STEMI and concomitant ischemic stroke, which was due to multiple coronary and cerebral septic embolisms.

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          Most cited references8

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          Neurologic manifestations of infective endocarditis: a 17-year experience in a teaching hospital in Finland.

          E Engblom, J Nikoskelainen, E. Kotilainen … (2000)
          Many previous studies have endeavored to find appropriate means to reduce the occurrence of neurologic manifestations in patients with infective endocarditis (IE). We evaluated patients with IE-associated neurologic complications and compared them with patients with IE who did not have neurologic symptoms. Particular attention was focused on assessing the impact of cardiac surgery and the presence of potential risk factors for complications on the outcome of the patients. A total of 218 episodes designated as definite or possible IE according to Duke criteria and treated during the years 1980 through 1996 in a Finnish teaching hospital were retrospectively evaluated for neurologic manifestations. Neurologic complications were identified in 55 episodes (25%), with an embolic event as the most frequent manifestation (23/55; 42%). In the majority (76%) of episodes, the neurologic manifestation was evident before antimicrobial treatment was started, being the first sign of IE in 47% of episodes. Only 1 recurrent cerebral embolization was observed. Neurologic complications were significantly associated with Staphylococcus aureus infection (29% vs 10%; P =.001) and with IE affecting both the aortic and the mitral valves (56% vs 23%; P<.01), but not with echocardiographic detection of vegetations or anticoagulant therapy. Death during the acute phase of IE occurred in 13 episodes (24%) with neurologic complications and in 17 episodes (10%) without neurologic complications (P<.03). In episodes with neurologic complications, the IE-associated mortality rate was 25% (10/40) in the medical treatment group and 20% (3/15) in the surgical group. No neurologic deterioration was observed in these surgically treated patients postoperatively. Our results reinforce the belief that rapid diagnosis and initiation of antimicrobial therapy may still be the most effective means to prevent neurologic complications. These data underscore the importance of diagnostic alertness to the prognosis of patients with IE.
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            Acute Coronary Syndrome in Infective Endocarditis

            María Manzano, Isidre Vilacosta, Jose Román … (2007)
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              Cardiac, cerebral, and vascular complications of infective endocarditis.

              C Cobbs, Reuben Harris (1996)
              The complications of IE may involve any organ system. Cardiac complications are frequently present, and heart failure remains a leading cause of death. Abscess formation in the surrounding cardiac tissues may result in myocardial or pericardial disease, and cardiac conduction abnormalities may develop. Extracardiac complications, including neurologic, vascular, and renal diseases, are also common and are usually caused by either embolization of vegetations or deposition of immune complexes. Despite many advancements in the detection and treatment of the complications of IE, management of these problems remains a challenging endeavor.
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                Author and article information

                Journal
                Journal ID (pmc): imas
                Journal ID (publisher-id): IMAS
                Title: Interventional Medicine and Applied Science
                Abbreviated Title: IMAS
                Publisher: Akadémiai Kiadó (Budapest )
                ISSN (Print): 2061-1617
                ISSN (Electronic): 2061-5094
                Publication date (Electronic, epub): 10 April 2018
                Publication date (Print, ppub): September 2018
                Volume: 10
                Issue: 3
                Pages: 157-161
                Affiliations
                [ 1 ]Department of Cardiology, Hitit University Çorum Training and Research Hospital , Çorum, Turkey
                [ 2 ]Faculty of Medicine, Department of Cardiology, Hitit University , Çorum, Turkey
                [ 3 ]Department of Neurology, Hitit University Çorum Training and Research Hospital , Çorum, Turkey
                Author notes
                [* ]Corresponding author: Macit Kalçık, MD; Faculty of Medicine, Department of Cardiology, Hitit University Çorum Training and Research Hospital, Yeniyol, Çamlik Cad. No:2, Çorum, Turkey; Phone: +90 536 4921789; Fax: +90 364 2230300; E-mail: macitkalcik@ 123456yahoo.com
                Article
                DOI: 10.1556/1646.10.2018.13
                PMC ID: 6343577
                SO-VID: 294cb217-02ab-490e-89d1-28e6be033ee5
                Copyright © © 2018 The Author(s)
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                History
                Date received : 03 August 2017
                Date revision received : 11 November 2017
                Date accepted : 17 February 2018
                Page count
                Figures: 4, Tables: 0, Equations: 0, References: 8, Pages: 5
                Funding
                Funding sources: None.
                Categories
                Subject: CASE REPORT

                ScienceOpen disciplines: Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
                Keywords: infective endocarditis,coronary embolism,vegetation,cerebral embolism,myocardial infarction
                Data availability:
                ScienceOpen disciplines: Medicine, Immunology, Health & Social care, Microbiology & Virology, Infectious disease & Microbiology
                Keywords: infective endocarditis, coronary embolism, vegetation, cerebral embolism, myocardial infarction

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