Coronary embolism and myocardial infarction associated with nonbacterial thrombotic endocarditis.

Six cases of coronary embolism and myocardial infarction associated with nonbacterial thrombotic endocarditis were seen at the Mount Sinai Hospital over a ten-year period. Every patient had an underlying malignant neoplasm. The vegetations were found on aortic, mitral, tricuspid and pulmonic valves and were located on the free or closure margins. The clinical diagnosis of this condition is difficult because of simultaneous embolization to the brain, causing widespread neurologic symptoms, but could be made by electrocardiographic and serum enzyme studies. Myocardial infarction caused the deaths of three patients. The relationship between nonbacterial thrombotic endocarditis, hypercoagulability, and disseminated intravascular coagulation is discussed.