Abstract 17621: Acute Coronary Syndrome Due to Septic Emboli From Infective Endocarditis

Abstract

Case Description: A 34-year-old female with a history of IV drug use and valvular infective endocarditis requiring multiple valve replacements presented with weakness and abdominal pain. She was found to be in septic shock requiring vasopressors and antibiotics. EKG was initially without ischemic changes. Imaging revealed multiorgan infarction including the spleen, left kidney, and parietal and temporal lobes of the brain with concomitant subarachnoid hemorrhage. TTE showed multiple masses on the mitral valve and new stenosis of the recently replaced tricuspid valve, concerning for multi-valvular involvement. LV systolic function was normal. Blood cultures were positive for MRSA and Strep agalactiae. Severe troponin elevation along with diffuse ST elevations in V3-6 prompted cardiology consultation, however intervention was deemed inappropriate due to presence of subarachnoid hemorrhage, thrombocytopenia and multiorgan failure. The patient was soon transitioned to comfort care after a discussion with family. Discussion: Acute coronary syndrome (ACS) secondary to infective endocarditis is a rarely cited phenomenon. Standardized management and treatment for ACS is difficult in the setting of co-existing multiorgan failure. In this case, our patient with infective endocarditis subsequently developed ACS secondary to septic emboli from large perivalvular vegetations. We emphasize vigilance for acute coronary events during infective endocarditis without source control.