Key result
NBTE secondary to occult cholangiocarcinoma can present as cardiogenic shock with anterior ST elevation.
Why the study?
Non-bacterial thrombotic endocarditis associated with cholangiocarcinoma is rare and usually diagnosed after thrombotic events or stroke, with limited case reports available.
Case Report (n=1)
Point-of-care echocardiography is critical for identifying alternative diagnoses such as non-bacterial thrombotic endocarditis in atypical STEMI presentations, a condition in which heparin is preferred over DOACs.
Answers are grounded in this paper and cite their sources.
Echocardiography may aid NBTE diagnosis in atypical cardiogenic shock; leaves open malignancy screening implications pending prospective data.
Non-bacterial thrombotic endocarditis (NBTE) associated with cholangiocarcinoma is rare, with only a few case reports described.The diagnosis is usually made after a thrombotic event or stroke.We report the case of a 44-year-old South African woman who presented with cardiogenic shock and ST elevation while receiving rivaroxaban for a recent pulmonary embolism.Autopsy revealed myocardial embolization secondary to NBTE associated with cholangiocarcinoma.This case highlights the value of point-of-care echocardiography in ruling out complications or alternative diagnoses in atypical presentations of acute coronary syndrome.Furthermore, it underscores that, in NBTE, anticoagulation with heparin is the preferred regimen.
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Hannesse et al. (2026) conducted a case report in Non-bacterial thrombotic endocarditis (n=1). Occult cholangiocarcinoma-associated non-bacterial thrombotic endocarditis was evaluated. Non-bacterial thrombotic endocarditis secondary to occult cholangiocarcinoma can present atypically as cardiogenic shock with anterior ST elevation.
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