Abstract
Most cases of non-bacterial thrombotic endocarditis (NBTE) tend to be related to malignancy or rheumatologic and autoimmune disorders like systemic lupus erythematosus. Rheumatoid arthritis (RA) itself has been associated with increased atherosclerosis, coronary artery plaque formation, and endothelial damage. However, it is rare to see NBTE in RA, simultaneously presenting with the acute coronary syndrome and acute limb ischemia due to distant embolization. Here we present a case of a 46-year-old female presenting with chest pain and right leg numbness, found to have ST-elevation myocardial infarction (STEMI) and occlusion of a peripheral artery due to embolization of vegetation present in the aortic valve. We also provide an extensive literature review of the relationship between NBTE and MI. One must be extra vigilant in managing these patients, especially if the size of vegetation is large as it has a tendency to embolize causing devastating complications.
Highlights
Most cases of non-bacterial thrombotic endocarditis (NBTE) tend to be related to malignancy
One must be extra vigilant in managing these patients, especially if the size of vegetation is large as it has a tendency to embolize causing devastating complications
Rheumatoid arthritis (RA) has been associated with NBTE as well as increased atherosclerosis, coronary artery plaque formation, and endothelial damage [1]. These lead to increase risk in coronary artery disease including myocardial infarction, stroke, and thromboembolic disease. It is rare for patients with RA to simultaneously present with NBTE, ST-elevation myocardial infarction (STEMI), and acute limb ischemia
Summary
Most cases of non-bacterial thrombotic endocarditis (NBTE) tend to be related to malignancy. Rheumatoid arthritis (RA) has been associated with NBTE as well as increased atherosclerosis, coronary artery plaque formation, and endothelial damage [1] These lead to increase risk in coronary artery disease including myocardial infarction, stroke, and thromboembolic disease. It is rare for patients with RA to simultaneously present with NBTE, ST-elevation myocardial infarction (STEMI), and acute limb ischemia. Given the ST changes and ongoing chest pain, the patient was taken immediately for cardiac catheterization which revealed a distal thrombus in the posterior left ventricular branch of the right coronary artery which was not amenable for intervention (Figures 3, 4). The patient was treated with systemic oral anticoagulation and was initiated on steroids
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