Acute coronary syndrome as the initial manifestation of infective endocarditis in an apparently normal native valve: a case report

Acute coronary syndrome is a rare complication of infectious endocarditis. We present the case of a patient with a bicuspid aortic valve who presented an acute ST elevation myocardial infarction (STEMI) of the inferior wall secondary to vegetation that generated obstruction of the ostium of the right coronary artery (RCA).

A 54-year-old patient with only a history of smoking was admitted for chest pain. An acute STEMI in the inferior wall was documented; he underwent an emergent coronary angiography, which showed a mass that obstructed the ostium of the RCA that did not allow its channelling. An angiotomography of the aorta was performed, where dissection was ruled out and the presence of a mass in the right coronary sinus that protruded towards the ostium of the coronary artery was confirmed. In the extension studies, a bicuspid aortic valve and thrombosis in the right brachial artery and in the infrarenal abdominal aorta were documented.

The case was taken to a medical meeting and given the embolic and mechanical compromise; it was decided to perform surgery where a mass that invaded the proximal segment of the RCA was resected. The histopathological study documented findings of vegetation; the cultures were positive for Staphylococcus epidermidis, and he finally received antibiotic and anticoagulation treatment.