A Case of Mitral Valve Infective Endocarditis and Atrial Fibrillation Complicated by Hemorrhagic Stroke: A Challenging Clinical Scenario and Approach to Management

Mubariz A Hassan; Niyati Grewal; Daniel Nepaul

doi:10.7759/cureus.41634

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A Case of Mitral Valve Infective Endocarditis and Atrial Fibrillation Complicated by Hemorrhagic Stroke: A Challenging Clinical Scenario and Approach to Management

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A Case of Mitral Valve Infective Endocarditis and Atrial Fibrillation Complicated by Hemorrhagic Stroke: A Challenging Clinical Scenario and Approach to Management

Mubariz A Hassan, Niyati Grewal and Daniel Nepaul

Curēus (Palo Alto, CA), Vol.15(7), e41634

07/10/2023

DOI: 10.7759/cureus.41634

PMCID: PMC10412743

PMID: 37575781

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Abstract

This case report presents a rare and intricate clinical scenario involving a 58-year-old male with a history of hypertension, intravenous drug use (IVDU), and cocaine abuse. The patient presented with profound hypotension and symptoms suggestive of impending shock. Septic workup revealed Staphylococcus aureus in all four blood culture bottles, confirming a diagnosis of infective endocarditis (IE). Transthoracic echocardiography demonstrated a large vegetation measuring 1.9x1.7 cm on the mitral valve. Additionally, the patient exhibited non-ST segment elevated myocardial infarction (NSTEMI) type II in the setting of cocaine use, atrial fibrillation, and therapeutic anticoagulation. Subsequent imaging studies raised concerns regarding hemorrhagic stroke. A multidisciplinary team comprising cardiology, cardiothoracic surgery, infectious disease, and neurology collaborated to develop an optimal management strategy. Considering the high-risk features of the IE and the need to address the hemorrhagic stroke, anticoagulation was temporarily halted, and the patient was transferred for urgent mitral valve replacement surgery. This case highlights the complex interplay between substance abuse, cardiovascular complications, IE, and neurological events, underscoring the challenges encountered in managing such patients.

Cardiology

Internal Medicine

Neurology

Details

Title: Subtitle: A Case of Mitral Valve Infective Endocarditis and Atrial Fibrillation Complicated by Hemorrhagic Stroke: A Challenging Clinical Scenario and Approach to Management
Creators: Mubariz A Hassan - Howard University Hospital
Niyati Grewal - Howard University Hospital
Daniel Nepaul - Howard University Hospital
Resource Type: Journal article
Publication Details: Curēus (Palo Alto, CA), Vol.15(7), e41634
DOI: 10.7759/cureus.41634
PMID: 37575781
PMCID: PMC10412743
NLM abbreviation: Cureus
ISSN: 2168-8184
eISSN: 2168-8184
Publisher: Cureus
Language: English
Date published: 07/10/2023
Academic Unit: Internal Medicine
Record Identifier: 9984920953102771

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