Objective: To present a case of miocardial infarction in which the diagnosis is made counterclock and it con-ducts to a whorse final diagnosis- infective endocardi-tis complicated with myocardial infarction by embolic mechanism.
Methods: M. N. is a 63 years old patient, known with anteroseptal myocardial infarction in 2015, when co-ronary angiogram was found to be normal, then, two years later it is reffered to our clinic as anteroseptal myo-cardial infaction, with 24 hours thoracic pain and with elevated myocardial necrosis markers (Troponin=46 ng/ml). Coronary angiogram revealed once again nor-mal coronary arteries. The pacient had history of severe mitral regurgitation caused by ruptured chordae. Echo-cardiogram revealed normal sistolic function of de left ventricle and severe mitral regurgitation with atached masses that consist with vegetation.
Results: On admission – pacient was hipotensive, ca-chectic, mild oedema of the inferior limbs and biologi-cally he had leukocytosis with neutrofilia, inflamatory syndrome, positive myocardial necrosis markers, but all of these you can find in the acute setting of myocardial infarction, so the diagnosis of infective endocarditis is still uncertain. We decided to administer empirical an-tibiotics for endocarditis, later on we have adapted to the antibiogram; the hemocultures was found positive for Enterococcus Faecalis. In pursuing the case we have found that the vegetations increased in dimension even thought the patient was undergoing correct antibiotic treatment. Facing the deterioration of the patient con-dition we tried to refer him to surgery, as the guidelines clearly state, but the patient refused and he continued to deteriorate to the point of multiple organ failure and death.
Conclusions: The particularity of this case is the fact that the embolisation occurred in same territory in both of the myocardial infarctions and that the valvular destruction was already there in 2015, facts that suggest this might be the case of an old non bacterial endo-carditis with subsequent infection.We did a cerebral cat scan that revealed multiples strokes in different areas of the brain that consists with our theory of preexistent non bacterial endocarditis, dating from the moment of the first embolisation proved, meaning the myocardi-al infarction from 2015. Infective endocarditis is still a cause of raised mortality and it might be difficult to diagnose, sometimes it is the complications that leads us to the final diagnosis. Surgery is important when in-dicated.