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March 5, 1982

Bacterial Endocarditis Complicated by Myocardial Infarction in a Pediatric Patient

JAMA. 1982;247(9):1315-1316. doi:10.1001/jama.1982.03320340069040

CLINICALLY apparent embolic episodes occur in about 20% of pediatric patients with bacterial endocarditis.1,2 Emboli most frequently involve the lungs, brain, extremities, spleen, kidneys, and mesenteric vessels.1-3 Emboli to the coronary arteries resulting in a myocardial infarction, while not uncommon in adults,4,5 are rare in children6 and usually result in sudden death.6-8 The purpose of this report is to draw attention to the fact that myocardial infarction can complicate bacterial endocarditis in children, to discuss the appropriate therapy, and to document the favorable long-term outcome in a patient who survived with conservative therapy.

Report of a Case  A 15-year-old girl was admitted to Hartford Hospital, Hartford, Conn, in November 1978 because of acute onset of abdominal pain. At age 6 years, she had had rheumatic fever characterized by arthritis, erythema marginatum rash, and carditis that resulted in mitral insufficiency. Since then, she has received monthly