Native mitral valve streptococcal endocarditis presenting as myocardial infarction and diagnosed with multimodality imaging

A man in his 60s presented to the emergency department with central crushing chest pain on a background of a week's history of flu-like symptoms. An ECG demonstrated ischaemia with blood tests confirming myocardial injury; catheter angiography revealed an obstructed diagonal coronary artery. In addition, blood tests revealed elevated markers of inflammation, blood cultures grew <i>Streptococcus gordonii</i> and transthoracic echocardiography demonstrated a mitral valve lesion. A diagnosis of embolic infarction secondary to native mitral valve infective endocarditis was made. Imaging with [¹⁸F]Flurodeoxyglucose Positron Emission Tomography CT, cardiac MRI and brain MRI confirmed myocardial infarction, mitral valve infection and embolic phenomena within the brain, respectively. This case reinforces the need for strategic flexibility when faced with evolving clinical data, the role of multidisciplinary involvement in an endocarditis team and the benefits of multimodality imaging techniques to secure diagnostic certainty.