An Unusual Case of Aortic Vegetation Causing Coronary Artery Microembolization and Sudden Death -- Case Report

Infective endocarditis is not uncommon. Complications of endocarditis may be related to hemodynamic instability through valve destruction and ensuing congestive heart failure. Embolization of vegetations is a known complication as well and may occur at any time, however there are certain high-risk features that predispose to distal embolization. This included vegetation size and causative organism especially with left heart valve endocarditis. Central nervous system or peripheral embolism to different parts of the body, may occur frequently and may be subclinical or overt. Embolization down the coronary arteries may cause myocardial ischemia, however, sudden cardiac death from infective endocarditis embolizing down a coronary artery is an extremely rare occurrence. The true incidence is not known, but in a recent study, 30 of 6000 (0.5%) cases of sudden cardiac death had a diagnosis of infective endocarditis as cause of death, with most cases being diagnosed post-mortem. Here, we present an unusual case of vegetation on the aortic valve that embolized down the left main coronary artery resulting in death.