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      Sudden death in infective endocarditis

      case-report

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          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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          Most cited references18

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          Infective endocarditis in adults.

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            Epidemiology of the antiphospholipid antibody syndrome.

            The prevalence of antiphospholipid antibodies in normals and SLE patients is reviewed. The frequency of complications of antiphospholipid antibodies (thrombosis, pregnancy morbidity) in the literature and in the Hopkins Lupus Cohort is summarized. Copyright 2000 Academic Press.
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              Diagnosis and management of infective endocarditis and its complications.

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                Author and article information

                Journal
                Autops Case Rep
                Autops Case Rep
                Autopsy & Case Reports
                São Paulo, SP: Universidade de São Paulo, Hospital Universitário
                2236-1960
                30 September 2016
                Jul-Sep 2016
                : 6
                : 3
                : 17-22
                Affiliations
                [a ]Anatomic Pathology Department - Instituto do Coração - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP – Brazil.
                [b ]Internal Medicine Department - Instituto do Coração - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP – Brazil.
                [c ]Infectious Disease Control Department - Instituto do Coração - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP – Brazil.
                Author notes

                Conflict of interest: None

                Correspondence 
 Jussara Bianchi Castelli 
 Avenida Dr. Enéas de Carvalho Aguiar, 44 – São Paulo/SP – Brazil 
 CEP: 05403-000 
 Phone: +55 (11) 2661-5077 
 Fax Number: +55 (11) 2661-5279 
 jussara.castelli@ 123456hc.fm.usp.br
                Article
                autopsy005816
                10.4322/acr.2016.045
                5087979
                27818954
                fd177bda-2fac-4bc7-b51d-6b3c11357158
                Autopsy and Case Reports. ISSN 2236-1960. Copyright © 2016.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the article is properly cited.

                History
                : 10 August 2016
                : 23 August 2016
                Categories
                Article / Autopsy Case Report

                lupus erythematosus, systemic,endocarditis,heart arrest,embolism,coronary vessels

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