Case report: third-degree atrioventricular block secondary to septic coronary artery embolism following infective endocarditis. Issue 5 (25th August 2020)

• Record Type: Journal Article
• Authors: Prashar, Abhisheik; Chen, Daniel; Youssef, George; Ramsay, David
• Editors: Cameli, Matteo; Vamvakidou, Anastasia; Jansen, Henning; Oguz, Didem; Thomson, Ross
• Is Part Of: European heart journal. Volume 4:Issue 5(2020)
• Page Start: 1
• Page End: 4
• Publication Date: 2020-08-25
• Subjects: Case report -- Conduction disease -- Infective endocarditis -- Septic embolism -- Acute coronary syndrome; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytaa193
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: 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.