Thrombolytic therapy for acute myocardial infarction in unsuspected infective endocarditis

A 73-year-old man with classical acute myocardial infarction treated conventionally with thrombolytic therapy (tenecteplase) developed severe chills, flushing, and fever about 1 h after the thrombolysis. Two days later, an echocardiogram revealed prolapse of the posterior leaflet of the mitral valve and mobile material (vegetation) attached to the leaflet. This course of events suggests a diagnosis of underlying infective endocarditis causing coronary embolus and bacteraemia secondary to partial mitral vegetation digestion.