A 46-year-old man with a history of intravenous drug use presented with 5 days of fever as high as 102°F. He was ill-appearing, tachycardic, and without a heart murmur. Labs revealed marked leukocytosis and elevated troponin-T to 1.31 ng/ml (0.00–0.10 ng/ml), and blood cultures grew methicillin-susceptible Staphylococcus aureus 12 h after collection. Transthoracic echocardiogram showed a 4-cm mobile vegetation on the aortic valve. Troponin-T peaked the next day at 4.83 ng/ml, and while he remained free of chest pain, EKG revealed new ST-segment elevations in the anterolateral leads concerning for an acute coronary syndrome. Coronary angiogram identified 100% occlusion of both the distal left anterior descending artery (LAD) and the second diagonal branch of the LAD, consistent with coronary artery emboli (Fig. 1). The patient underwent aortic valve replacement and a one-vessel LAD bypass. A perforated aortic valve leaflet and multiple vegetations were seen on gross examination (Fig. 2). He was treated with intravenous cefazolin for 4 weeks.
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Shah, A.M., Bello, R.A. & Galen, B.T. Coronary Artery Embolism from Large Aortic Valve Vegetation due to Staphylococcus aureus Endocarditis. J GEN INTERN MED 32, 582 (2017). https://doi.org/10.1007/s11606-016-3935-4
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DOI: https://doi.org/10.1007/s11606-016-3935-4