Infective endocarditis presenting with myocardial infarction with non-obstructive coronary arteries: A case report and literature review.
Lan Cheng, Lianjie Li
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Case in brief
A 52-year-old male on long-term hemodialysis presented with acute chest pain, shortness of breath, and sweating. Initial ECG showed ST-segment depression, and elevated troponin I levels indicated myocardial infarction. Coronary angiography revealed no significant stenosis, but echocardiography suggested infective endocarditis with aortic valve vegetation. The patient underwent aortic valve replacement and was treated with antibiotics, leading to significant clinical improvement and discharge.
What made this case unusual
The case highlights myocardial infarction with non-obstructive coronary arteries (MINOCA) as a rare presentation of infective endocarditis in a patient with uremia and multiple comorbidities.
Diagnostic / clinical pearl
Clinicians should consider infective endocarditis in patients with atypical presentations of myocardial infarction, especially those on hemodialysis.
Why it matters
This case underscores the importance of early imaging and multidisciplinary approaches in diagnosing and managing complex cases of MINOCA and infective endocarditis.