Sudden cardiac death due to coronary artery embolism secondary to native aortic valve endocarditis in a young adult

Systemic embolism is a common complication of infective endocarditis, most frequently involving the central nervous system, spleen, kidney, liver, and iliac or mesenteric arteries, but embolisation to coronary artery causing sudden cardiac death is infrequently encountered. A case of a 45-year-old male who had a coiling procedure for anterior communicating artery aneurysm 6 weeks prior to his death. He was asymptomatic until a week prior to his death. The decedent had a fever and was treated for urinary tract infection with oral cefuroxime. He had a sudden onset of breathlessness and died at his home. Post mortem examination revealed a dilated aortic valve with vegetation. Part of the vegetation dislodged in the left coronary ostium and caused luminal occlusion. The left kidney showed scarred surface and poorly demarcated corticomedullary junction. However, the right kidney and urinary bladder were unremarkable. Microscopic examination revealed the septic thrombus both on the valve and in the left coronary ostium extended to the left main stem coronary artery. However, there was no evidence of myocardial ischemia. Blood culture grew Enterococcus faecalis which are usually associated with intravenous procedure and urinary tract infection. The culture from the vegetation also grew Enterococcus species. The left kidney also showed microscopic evidence of chronic pyelonephritis. This case highlights the rare complication of infective endocarditis which caused sudden cardiac death.