Why the study?
Septic coronary emboli is an extremely rare complication of infective endocarditis, reported in <1% of cases, that generally requires multi-modal imaging to diagnose.
This case highlights that septic coronary embolism, a rare complication of infective endocarditis, can present as third-degree atrioventricular block.
Rare septic coronary embolus in IE may prompt broader imaging in atypical cases; leaves open questions on incidence and management.
BACKGROUND: Coronary artery emboli can occur from a number of rare causes such as arterial thrombo-embolus or septic embolus. This diagnosis generally requires multi-modal imaging including echocardiography, computed tomography, or invasive coronary angiography. Septic coronary emboli is an extremely rare consequence of infective endocarditis (IE), having been reported in <1% of all cases. CASE SUMMARY: A 54-year-old previously healthy Tibetan monk presented feeling generally unwell and lethargic. Electrocardiogram demonstrated sinus rhythm, third-degree atrioventricular block with a left bundle branch escape. Initial transthoracic and transoesophageal echocardiography demonstrated vegetations on the aortic and tricuspid valve as well as intra-myocardial abscess. Coronary angiography revealed septic embolus involving the septal perforator coronary artery. He underwent surgical replacement of the infected valves and debridement and repair of a ventricular septal defect. DISCUSSION: Infective endocarditis can predispose to a range of cardiac pathology. This case demonstrates that patients can present with cardiac conduction disease from a septic embolus involving a coronary artery as a complication of IE.
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Prashar et al. (2020) studied this question.
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