Non-bacterial Thrombotic Endocarditis Presenting as Cardiogenic Shock With Anterior ST Elevation Revealing an Occult Cholangiocarcinoma: A Case Report

Non-bacterial thrombotic endocarditis (NBTE) associated with cholangiocarcinoma is rare, with only a few case reports described.The diagnosis is usually made after a thrombotic event or stroke.We report the case of a 44-year-old South African woman who presented with cardiogenic shock and ST elevation while receiving rivaroxaban for a recent pulmonary embolism.Autopsy revealed myocardial embolization secondary to NBTE associated with cholangiocarcinoma.This case highlights the value of point-of-care echocardiography in ruling out complications or alternative diagnoses in atypical presentations of acute coronary syndrome.Furthermore, it underscores that, in NBTE, anticoagulation with heparin is the preferred regimen.