PT - JOURNAL ARTICLE AU - Zhong Chen AU - Francesca Ng AU - Thuraia Nageh TI - An unusual case of infective endocarditis presenting as acute myocardial infarction AID - 10.1136/emj.2006.043000 DP - 2007 Jun 01 TA - Emergency Medicine Journal PG - 442--443 VI - 24 IP - 6 4099 - http://emj.bmj.com/content/24/6/442.short 4100 - http://emj.bmj.com/content/24/6/442.full SO - Emerg Med J2007 Jun 01; 24 AB - A 39-year-old Zimbabwean man presented with a 1 week history of fever, general malaise and acute-onset chest pain. He had a urethral stricture, which had been managed with an indwelling supra-pubic catheter. The electrocardiography on admission showed inferior ST-T segments elevation. His chest pain and electrocardiography changes resolved subsequent to thrombolysis, and he remained haemodynamically stable. The 12-h troponin I was increased at 10.5 μg/l (NR <0.04 μg/l). Echocardiography confirmed severe mitral regurgitation and a flail anterior mitral valve leaflet with an independently oscillating mobile vegetation. Enterococci faecalis were grown on blood cultures. A diagnosis of enterococci infective endocarditis with concomitant acute myocardial infarction due to possible septic emboli was made. Despite the successful outcome from thrombolysis in the setting of acute myocardial infarction with infective endocarditis, the case highlights the current lack of definitive data on the optimal acute management of such an unusual clinical scenario. Although there is serious concern that thrombolytic treatment for myocardial infarction in the setting of infective endocarditis may be associated with higher risk of cerebral haemorrhage, there is little documented evidence supporting the safety of primary percutaneous coronary intervention with these patients.