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

Infective endocarditis (IE) is a life-threatening condition with increasing prevalence and high mortality, particularly among intravenous drug users (IVDU). While heart failure is a common complication, sudden cardiac death (SCD) due to coronary embolization is a rare event. We report a case of a 35-year-old male with a history of IVDU who presented with fever, chest discomfort, and dyspnea following a traumatic burn injury. Blood cultures grew methicillin-sensitive <i>Staphylococcus aureus</i>, and transthoracic echocardiography (TTE) revealed severe aortic valve endocarditis with large vegetations. The patient developed acute coronary occlusion involving multiple branches, with echocardiographic imaging confirming a vegetation prolapsing into the left main coronary artery. Despite appropriate medical management of the IE, he suffered cardiac arrest prior to being able to undergo surgery, presumed to be due to the recurrent acute coronary event related to vegetation obstruction or embolization. Coronary embolization from IE remains an underrecognized but severe complication, with limited reported cases of SCD due to vegetation prolapse into the coronary arteries. This case highlights the importance of early recognition of embolic complications in IE, especially in high-risk patients such as those with IVDU and large vegetations with embolic risk, and underscores the potential need for urgent surgical intervention to prevent fatal outcomes.