Emine KÜÇÜKATEŞ, Nazmi GÜLTEKİN, Gülsüm BULUT

A coronary septic embolism in double prosthetic valve endocarditis presenting as acute anteroseptal ST-segment-elevation myocardial infarction

Septik emboli nedeniyle ortaya çıkan akut miyokard infarktüsü genellikle ölümcüldür. 40 yaşındaki erkek hasta 30 dakikadan beri süregelen şiddetli göğüs ağrısıyla acil servise başvurdu. Elektrokardiyogram V1-V4 derivasyonlarında maksimum 6 mm akut ST elevasyonları gösterdi. Hastanın ateşi 38.5ºC civarında idi. Parenteral ampisilin/subaktam tedavisi başlanmadan önce 3 defa kan kültür örneği alındı. Daha sonra hastanın kan kültürlerinde koagülaz negatif stafiolokok (Metisilin Duyarlı Staphylococcus epidermidis) tanımlandı. Koroner anjiyografik incelemesi yapıldı. İnceleme sonunda sol ön inen dalın (LAD) orta bölgesinde lobule kenarlı septik embolus gösterildi.Trans-özefegeal ekokardiyografik incelemede prostetik mitral ve aort kapak üzerinde çoklu mobil vegetasyonlar saptandı. Altı haftalık antbiyoterapiden sonra hasta tamamen iyileşti ve hastaneden çıkarıldı. Altı ay sonra tekrar hastaneye yatırılan hasta tekrarlayan infektif endokarditin komplikasyonlarından kaybedildi.

Çift prostetik kapak endokarditine bağlı koroner septik embolinin neden olduğu akut anteroseptal ST-segment-elevasyonlu miyokard infarktüsü

Acute myocardial infarction caused by septic embolism is usually fatal. A 40-year-old male patient who presented within 30 minutes of severe chest pain was admitted to the emergency department. An electrocardiogram showed a maximum 6 mm of acute ST elevations at V1-V4 derivations. His body temperature was as high as 38.5ºC. Blood cultures were taken three times before parenteral ampicillin/ sulbactam treatment was administered. Later, coagulase negative staphylococci (Methicillin Sensitive Staphylococcus epidermidis) were identified from his blood cultures. Coronary angiographic examination was performed. Lobulated contours of a septic embolus was shown in the mid region of left anterior descending artery as an outcome. Trans-esophageal echocardiography showed; mobile multiple vegetations on the prosthetic mitral and aorta valves. After six weeks of antibiotherapy, he was completely healed and discharged from hospital.Six months later, he was rehospitalized and died because of complications of recurrent infective endocarditis.

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