Luther et al. Journal of Medical Case Reports 2011, 5:408 http://www.jmedicalcasereports.com/content/5/1/408 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Chest pain with ST segment elevation in a patient with prosthetic aortic valve infective endocarditis: a case report Vishal Luther1*, Refai Showkathali2 and Reto Gamma2 Abstract Introduction: Acute ST-segment elevation myocardial infarction secondary to atherosclerotic plaque rupture is a common medical emergency. This condition is effectively managed with percutaneous coronary intervention or thrombolysis. We report a rare case of acute myocardial infarction secondary to coronary embolisation of valvular vegetation in a patient with infective endocarditis, and we highlight how the management of this phenomenon may not be the same. Case presentation: A 73-year-old British Caucasian man with previous tissue aortic valve replacement was diagnosed with and treated for infective endocarditis of his native mitral valve. His condition deteriorated in hospital and repeat echocardiography revealed migration of vegetation to his aortic valve. Whilst waiting for surgery, our patient developed severe central crushing chest pain with associated anterior ST segment elevation on his electrocardiogram. Our patient had no history or risk factors for ischaemic heart disease. It was likely that coronary embolisation of part of the vegetation had occurred. Thrombolysis or percutaneous coronary intervention treatments were not performed in this setting and a plan was made for urgent surgical intervention. However, our patient deteriorated rapidly and unfortunately died. Conclusion: Clinicians need to be aware that atherosclerotic plaque rupture is not the only cause of acute myocardial infarction. In the case of septic vegetation embolisation, case report evidence reveals that adopting the current strategies used in the treatment of myocardial infarction can be dangerous. Thrombolysis risks intra-cerebral hemorrhage from mycotic aneurysm rupture. Percutaneous coronary intervention risks coronary mycotic aneurysm formation, stent infections as well as distal septic embolisation. As yet, there remains no defined treatment modality and we feel all cases should be referred to specialist cardiac centers to consider how best to proceed. Introduction Atherosclerotic plaque rupture within a coronary vessel can lead to rapid vessel occlusion and subsequent myo- cardial ischaemia and necrosis [1]. Risk factors for the development of atherosclerosis include hypertension, diabetes mellitus, high cholesterol, a history of smoking, and a family history of atherosclerotic disease [2]. Cur- rent treatment involves either percutaneous coronary intervention (PCI) to relieve the occlusion, or thrombo- lysis to dissolve the occlusion [3]. * Correspondence: vishal_luther@yahoo.co.uk 1Department of Medicine, Whittington Hospital NHS Trust, Magdala Avenue, London, N19 5NF, UK Full list of author information is available at the end of the article There are more rare causes of acute myocardial infarction (AMI). We present and discuss the case of a patient with AMI secondary to embolisation of vegeta- tion sitting on a prosthetic aortic valve in a patient with confirmed aortic valve infective endocarditis (IE). Case presentation A 73-year-old British Caucasian man who had under- gone a tissue aortic valve replacement five years pre- viously was admitted to his local hospital with a two- week history of breathlessness, general malaise and night sweats. On examination, he was found to have an ejection systolic murmur in the aortic area and a pan- systolic murmur in the mitral area radiating to the axilla. His white cell count was elevated (15.1 × 109 © 2011 Luther et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.