Septic Coronary Embolism in Recurrent Infective Endocarditis Causing Acute Myocardial Infarction

BACKGROUND: Acute coronary syndrome is an uncommon but serious complication of infective endocarditis (IE), most often caused by septic embolism. CASE SUMMARY: A 30-year-old man with mitral valve prolapse and prior IE presented with chest pain, dyspnea, and fever. Electrocardiogram showed anterior ST-segment elevation, and coronary angiography demonstrated distal left anterior descending artery occlusion with otherwise normal coronaries. Plain balloon angioplasty without stent was performed given the embolic nature of the lesion. Blood cultures grew Staphylococcus hominis. Transesophageal echocardiography revealed severe mitral regurgitation with leaflet perforation and vegetations, whereas computed tomography revealed hepatic infarction as systemic embolization. He underwent early mitral valve repair after antibiotics and recovered well. DISCUSSION: Coronary embolism complicating IE is rare (∼2% incidence) but associated with high morbidity and mortality. This case underscores the need to suspect septic coronary embolism in acute coronary syndrome with normal coronaries, avoid fibrinolysis, and pursue percutaneous coronary intervention without stenting followed by early surgical intervention. TAKE-HOME MESSAGE: Early recognition of septic coronary embolism and timely multidisciplinary intervention are essential to optimize outcomes.