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Philip M, Hourdain J, Resseguier N, Gouriet F, Casalta JP, Arregle F, Hubert S, Riberi A, Mouret JP, Mardigyan V, Deharo JC, Habib G. Atrioventricular conduction disorders in aortic valve infective endocarditis. Arch Cardiovasc Dis 2024; 117:304-312. [PMID: 38704289 DOI: 10.1016/j.acvd.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Aortic valve infective endocarditis may be complicated by high-degree atrioventricular block in up to 10-20% of cases. AIM To assess high-degree atrioventricular block occurrence, contributing factors, prognosis and evolution in patients referred for aortic infective endocarditis. METHODS Two hundred and five patients referred for aortic valve infective endocarditis between January 2018 and March 2021 were included in this study. A comprehensive assessment of clinical, electrocardiographic, biological, microbiological and imaging data was conducted, with a follow-up carried out over 1 year. RESULTS High-degree atrioventricular block occurred in 22 (11%) patients. In univariate analysis, high-degree atrioventricular block was associated with first-degree heart block at admission (odds ratio 3.1; P=0.015), periannular complication on echocardiography (odds ratio 6.9; P<0.001) and severe biological inflammatory syndrome, notably C-reactive protein (127 vs 90mg/L; P=0.011). In-hospital mortality (12.7%) was higher in patients with high-degree atrioventricular block (odds ratio 4.0; P=0.011) in univariate analysis. Of the 16 patients implanted with a permanent pacemaker for high-degree atrioventricular block and interrogated, only four (25%) were dependent on the pacing function at 1-year follow-up. CONCLUSIONS High-degree atrioventricular block is associated with high inflammation markers and periannular complications, especially if first-degree heart block is identified at admission. High-degree atrioventricular block is a marker of infectious severity, and tends to raise the in-hospital mortality rate. Systematic assessment of patients admitted for infective endocarditis suspicion, considering these contributing factors, could indicate intensive care unit monitoring or even temporary pacemaker implantation in those at highest risk.
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Affiliation(s)
- Mary Philip
- Cardiology Department, La Timone Hospital, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - Jérôme Hourdain
- Cardiology Department, La Timone Hospital, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Noémie Resseguier
- Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix-Marseille University, Inserm, IRD, 13385 Marseille, France; Biostatistics and Information and Communication Technology Department, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Frédérique Gouriet
- IHU-Méditerranée Infection, Aix-Marseille University, IRD, AP-HM, MEPHI, 13005 Marseille, France
| | - Jean-Paul Casalta
- IHU-Méditerranée Infection, Aix-Marseille University, IRD, AP-HM, MEPHI, 13005 Marseille, France
| | - Florent Arregle
- Cardiology Department, La Timone Hospital, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Sandrine Hubert
- Cardiology Department, La Timone Hospital, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Alberto Riberi
- Cardiac Surgery Department, La Timone Hospital, AP-HM, 13005 Marseille, France
| | - Jean-Philippe Mouret
- Cardiology Department, La Timone Hospital, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Vartan Mardigyan
- Cardiology Department, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Jean-Claude Deharo
- Cardiology Department, La Timone Hospital, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Gilbert Habib
- Cardiology Department, La Timone Hospital, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
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Kunal S, Shah B, Bagarhatta R, Verma H. Perforated cuspal aneurysm of aortic valve following infective endocarditis presenting as complete heart block: a case report and review of literature. Eur Heart J Case Rep 2022; 6:ytac183. [PMID: 35542826 PMCID: PMC9081599 DOI: 10.1093/ehjcr/ytac183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/24/2022]
Abstract
Aortic cuspal aneurysm is a rare clinical entity and often occurs as a complication of infective endocarditis. We report a case of a 30-year-old male with no prior comorbid conditions who presented with fever, acute onset shortness of breath, and chest pain along with multiple episodes of syncope. Electrocardiogram revealed complete heart block while two-dimensional echocardiogram was suggestive of perforated aortic cuspal aneurysm with aortic regurgitation. Blood cultures were positive for Streptococcus viridans. The patient was initiated on broad spectrum antibiotics, temporary pacemaker implantation, and subsequently underwent aortic valve replacement followed by permanent pacemaker implantation after 6 weeks. A diagnosis of perforated aortic cuspal aneurysm subsequent to infective endocarditis was made. This was based on clinical presentation, echocardiographic evaluation, blood cultures, and surgical as well as histopathological findings.
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Affiliation(s)
- Shekhar Kunal
- Department of Cardiology, ESIC Medical College, Faridabad, Haryana, India
| | - Bhushan Shah
- Department of Cardiology, Rajiv Gandhi Superspeciality Hospital, Delhi, India
| | - Rajeev Bagarhatta
- Department of Cardiology, SMS Medical College, Jaipur, Rajasthan, India
| | - Hemlata Verma
- Department of CTVS, SMS Medical College, Jaipur, Rajasthan, India
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3
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Seo JW, Kim SS, Kim HK, Jeong JH. Pneumococcal Endocarditis Presenting as Sinus Arrest. J Cardiovasc Imaging 2022; 30:219-221. [PMID: 35879260 PMCID: PMC9314221 DOI: 10.4250/jcvi.2021.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jun-Won Seo
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Sung Soo Kim
- Department of Cardiovascular Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Hyun Kuk Kim
- Department of Cardiovascular Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Jae Han Jeong
- Department of Thoracic and Cardiovascular Surgery, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C, O'Gara PT, Beckman JA, Levine GN, Al-Khatib SM, Armbruster A, Birtcher KK, Ciggaroa J, Deswal A, Dixon DL, Fleisher LA, de las Fuentes L, Gentile F, Goldberger ZD, Gorenek B, Haynes N, Hernandez AF, Hlatky MA, Joglar JA, Jones WS, Marine JE, Mark D, Palaniappan L, Piano MR, Spatz ES, Tamis-Holland J, Wijeysundera DN, Woo YJ. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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5
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 857] [Impact Index Per Article: 285.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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6
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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7
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Jamal SM, Kichloo A, Albosta M, Bailey B, Singh J, Wani F, Shah Zaib M, Ahmad M, Khan MD, Soni R, Aljadah M, Khan HW, Khan M, Khan MZ. In-hospital outcomes and prevalence of comorbidities in patients with infective endocarditis with and without heart blocks: Insight from the National Inpatient Sample. J Investig Med 2020; 69:358-363. [PMID: 33115957 DOI: 10.1136/jim-2020-001501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 11/03/2022]
Abstract
Infective endocarditis (IE) complicated by heart block can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart block are lacking. Patients with a primary diagnosis of IE with or without heart block were identified by querying the Healthcare Cost and Utilization Project database, specifically the National Inpatient Sample for the years 2013 and 2014, based on International Classification of Diseases Clinical Modification Ninth Revision codes. During 2013 and 2014, a total of 18,733 patients were admitted with a primary diagnosis of IE, including 867 with concurrent heart blocks. Increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), and cost of care ($282,573 vs $223,559) were found for patients with IE complicated by heart block. Additionally, these patients were more likely to develop cardiogenic shock (8.9% vs 3.2%), acute kidney injury (40.1% vs 32.6%), and hematologic complications (19.3% vs 15.2%), and require placement of a pacemaker (30.6% vs 0.9%). IE and concurrent heart block resulted in increased requirement for aortic (25.7% vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements. Conclusion was made that IE with concurrent heart block worsens in-hospital mortality, length of stay, and cost for patients. Our analysis demonstrates an increase in cardiac procedures, specifically aortic and/or mitral valve replacements, and Implantable Cardiovascular Defibrillator/Cardiac Resynchronization Therapy/ Permanent Pacemaker (ICD/CRT/PPM) placement in IE with concurrent heart block. A close telemonitoring system and prompt interventions may represent a significant mitigation strategy to avoid the adverse outcomes observed in this study.
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Affiliation(s)
- Shakeel M Jamal
- Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Asim Kichloo
- Department of Internal Medicine, CMU Medical Education Partners, Saginaw, Michigan, USA
| | - Michael Albosta
- Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Beth Bailey
- Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Jagmeet Singh
- Department of Internal Medicine/Division of Nephrology, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Farah Wani
- Department of Family Medicine, Samaritan Medical Center, Watertown, NY, USA
| | | | - Muhammad Ahmad
- Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
| | | | - Ronak Soni
- Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA
| | - Michael Aljadah
- Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Hafiz Waqas Khan
- Department of Internal Medicine, Michigan State University, Flint, Michigan, USA
| | - Mahin Khan
- Department of Internal Medicine, Michigan State University, Flint, Michigan, USA
| | - Muhammad Z Khan
- Department of Internal Medicine, West Virginia University, Morgantown, West Virginia, USA
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Agrawal T, Irani M, Fuentes Rojas S, Jeroudi O, Janjua E. A Rare Case of Infective Endocarditis Caused by Gemella haemolysans. Cureus 2019; 11:e6234. [PMID: 31890433 PMCID: PMC6935327 DOI: 10.7759/cureus.6234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Gemella haemolysans is a gram-positive coccoid, facultative anaerobe of the mucous membranes. In rare cases, it has been identified as an opportunistic pathogen in the development of endocarditis. Here, we describe a case of infective endocarditis in a patient with a bicuspid aortic valve. A 38-year-old man presented with the complaint of exertional dyspnea of one month duration. He was found to have leucocytosis and his blood cultures grew Gemella haemolysans. Trans-esophageal echocardiography showed a bicuspid aortic valve with 1.5 x 1.5 cm vegetative mass, severe aortic regurgitation, and an aortic root abscess. The patient was started on intravenous ampicillin and gentamycin. He then underwent mechanical aortic valve replacement and bovine reconstruction of the left ventricular outflow tract. Our case highlights the importance of considering atypical pathogens as causative agents of infective endocarditis.
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Affiliation(s)
| | - Malcolm Irani
- Internal Medicine, Houston Methodist Hospital, Houston, USA
| | | | - Omar Jeroudi
- Cardiology, Debakey Heart and Vascular Center, Houston Methodist Hospital, Houston, USA
| | - Ejaz Janjua
- Internal Medicine, Houston Methodist Hospital, Houston, USA
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9
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Halford B, Piazza MB, Berka H, Taylor C. Blocking a rash diagnosis: a rare case of infective endocarditis. BMJ Case Rep 2019; 12:12/3/e226213. [PMID: 30898951 DOI: 10.1136/bcr-2018-226213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a previously healthy, afebrile patient who presented with subacute bilateral lower extremity rash and complete heart block, which was later found to be secondary to infective endocarditis. His transoesophageal echocardiogram detected multiple vegetations and blood cultures were positive for Granulicatella adiacens, a nutritionally variant streptococcus that is a normal component of oral flora and thought to be responsible for approximately 5% of all cases of streptococcal endocarditis. Due to concerns for renal failure, the patient was treated with an unconventional regimen of ampicillin and ceftriaxone. He underwent a valve replacement and pacemaker placement and has done well since hospital discharge.
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Affiliation(s)
- Brittne Halford
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Haley Berka
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Caitlin Taylor
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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10
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 70:252-289. [PMID: 28315732 DOI: 10.1016/j.jacc.2017.03.011] [Citation(s) in RCA: 1841] [Impact Index Per Article: 263.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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11
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Arai M, Nagashima K, Kato M, Akutsu N, Hayase M, Ogura K, Iwasawa Y, Aizawa Y, Saito Y, Okumura Y, Nishimaki H, Masuda S, Hirayama A. Complete Atrioventricular Block Complicating Mitral Infective Endocarditis Caused by Streptococcus Agalactiae. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:650-4. [PMID: 27604147 PMCID: PMC5017695 DOI: 10.12659/ajcr.898142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 74 Final Diagnosis: Infective endocarditis Symptoms: Apetite loss • fever Medication: — Clinical Procedure: Transesophageal echocardiography Specialty: Cardiology
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Affiliation(s)
- Masaru Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Mahoto Kato
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Naotaka Akutsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Misa Hayase
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kanako Ogura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yukino Iwasawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihiro Aizawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuki Saito
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Haruna Nishimaki
- Department of Pathology, Nihon University School of Medicine, Tokyo, Japan
| | - Shinobu Masuda
- Department of Pathology, Nihon University School of Medicine, Tokyo, Japan
| | - Astushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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12
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Glancy DL. Intermittent High-Grade Atrioventricular Block in a Man With Infective Endocarditis. Am J Cardiol 2016; 117:1855. [PMID: 27087175 DOI: 10.1016/j.amjcard.2016.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/11/2016] [Accepted: 03/11/2016] [Indexed: 11/25/2022]
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13
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Vezzosi T, Marchesotti F, Tognetti R, Domenech O. ECG of the Month. Atrioventricular block (AVB). J Am Vet Med Assoc 2016; 248:1004-6. [PMID: 27074607 DOI: 10.2460/javma.248.9.1004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Brown RE, Chiaco JMC, Dillon JL, Catherwood E, Ornvold K. Infective Endocarditis Presenting as Complete Heart Block With an Unexpected Finding of a Cardiac Abscess and Purulent Pericarditis. J Clin Med Res 2015; 7:890-5. [PMID: 26491503 PMCID: PMC4596272 DOI: 10.14740/jocmr2228w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 12/14/2022] Open
Abstract
Intracardiac abscess resulting in complete heart block is an infrequent complication of infective endocarditis. Most presentations of endocarditis are limited to valvular and perivalvular structures, with varying degrees of heart block occurring in the minority of cases. We report a case of endocarditis manifesting as chest pain associated with ST segment elevation and complete heart block. The patient expired unexpectedly within a few hours of presentation. Postmortem examination revealed an atrial septal abscess, purulent pericardial collection, and fibrinous pericarditis. Spread of the abscess into the atrial septum was postulated to be the cause of the complete heart block. In endocarditis, the ominous development of heart block and a poor response to antibiotic therapy imply significant extension of the infection. Management therefore requires prompt ventricular pacing with consideration for valve replacement and possible pericardial drainage.
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Affiliation(s)
- Randolph E Brown
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - John Michael Chua Chiaco
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Jessica L Dillon
- Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Edward Catherwood
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Kim Ornvold
- Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Creager MA, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Stevenson WG, Yancy CW. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Thorac Cardiovasc Surg 2014; 148:e1-e132. [DOI: 10.1016/j.jtcvs.2014.05.014] [Citation(s) in RCA: 631] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:2438-88. [PMID: 24603191 DOI: 10.1016/j.jacc.2014.02.537] [Citation(s) in RCA: 1359] [Impact Index Per Article: 135.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Transient trifascicular block secondary to tricuspid valve endocarditis. Rev Esp Cardiol 2012; 65:767-8. [PMID: 22361275 DOI: 10.1016/j.recesp.2011.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 10/05/2011] [Indexed: 11/21/2022]
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18
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Complete heart block associated with tricuspid valve endocarditis due to extended spectrum β-lactamase-producing Escherichia coli. Can J Cardiol 2011; 27:263.e17-20. [PMID: 21459281 DOI: 10.1016/j.cjca.2010.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 06/15/2010] [Indexed: 02/07/2023] Open
Abstract
We report a case of complete heart block associated with tricuspid endocarditis due to extended-spectrum β-lactamase-producing Escherichia coli (ESBL E. coli) following a transrectal prostate biopsy. This is the first report of complete heart block associated with tricuspid native valve endocarditis. In addition, this is also the first reported case of ESBL E. coli causing endocarditis of any kind. Prompt antibiotic therapy resulted in a downgrading of the high-grade conduction block and eventual cure of an associated complication, vertebral osteomyelitis, and discitis. The anatomy and microbiology of endocarditis in the context of heart block are presented and discussed.
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19
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Presence of conduction abnormalities as a predictor of clinical outcomes in patients with infective endocarditis. Heart Vessels 2011; 26:298-305. [DOI: 10.1007/s00380-010-0055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 04/23/2010] [Indexed: 10/18/2022]
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20
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Dayan V, Gutierrez F, Cura L, Soca G, Lorenzo A. Two cases of pulmonary homograft replacement for isolated pulmonary valve endocarditis. Ann Thorac Surg 2009; 87:1954-6. [PMID: 19463639 DOI: 10.1016/j.athoracsur.2008.10.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 10/07/2008] [Accepted: 10/14/2008] [Indexed: 10/20/2022]
Abstract
Isolated pulmonary endocarditis is rare. Two cases that required surgical treatment are reported: a 35-year-old woman with predisposing factors for right-sided endocarditis who presented with complete heart block; and a healthy 65-year-old man with no predisposing factors who was admitted with septic shock. Both patients presented with septic shock and pulmonary septic emboli requiring urgent surgical treatment. Surgical correction using pulmonary homograft was done, with immediate postoperative recovery. The current literature of isolated pulmonary endocarditis is also reviewed.
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Affiliation(s)
- Victor Dayan
- Cardiovascular Centre, Hospital de Clinicas, Montevideo, Uruguay.
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Bramanti O, Di Bella G, Carerj S. Complete atrioventricular block in a young adult due to calcified damage of the His bundle system. Can J Cardiol 2009; 25:167. [PMID: 19279987 DOI: 10.1016/s0828-282x(09)70053-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- O Bramanti
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Italy
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Abstract
Echocardiography is a most useful bedside tool to help in the diagnosis and subsequent management of patients with infective endocarditis. Transesophageal echocardiography provides complementary and often incremental information necessary in making a diagnosis, and in identifying associated intracardiac complications. This chapter will focus on the role of echocardiography in the diagnosis and management of infective endocarditis.
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Massoure PL, Kéreun E, Chevalier JM, Rigollaud JM, Bire F, Clémenty J, Roudaut R. [Severity of aortic ring abscess complicated by cardiac conduction abnormalities]. Ann Cardiol Angeiol (Paris) 2005; 54:132-7. [PMID: 15991468 DOI: 10.1016/j.ancard.2004.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine clinical features, management and prognosis of cardiac conduction abnormalities (CCA) complicating abscessed endocarditis. METHODS We have analysed clinical, microbiologic and echocardiographic datas, therapies and outcome of cardiac abscesses complicated by CCA in patient hospitalized between 1995 and 2001 in our centre. RESULTS Above 35 cardiac abscesses, six men (mean age 62 years) had CCA complicating six aortic ring abscesses (4 on native valve and 2 on prosthetic valve) with four cases of interventricular septal involvement and fistulization. Severe heart failure is present four times, a septic cerebral embolization twice. Streptococcus and Staphylococcus prevail. Complete atrioventricular block (AVB) reveals endocarditis twice and complicates the evolution three times. Trifascicular block (first degree AVB, left anterior fascicular block and complete right bundle branch block) revealed recurrence of endocarditis. Two patients were treated medically: one died quickly (complete AVB pre-mortem), and the other one had favourable issue (paroxystic complete AVB). Four patients had surgery with temporary pacemaker in three cases (one died) then definitive pacemaker in two cases. At 26.5 month (7-50), the four survivors had no recurrence of endocarditis. CONCLUSION Severe CCA are classical in aortic ring abscessed endocarditis and associated with increased mortality. Immediate transfert in a dentre with cardiac surgery is necessary. Definitive cardiac pacing can be performed early without leads infection.
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Affiliation(s)
- P L Massoure
- Service de Cardiologie, Hôpital des Armées R-Picqué, Bordeaux, France.
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25
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Petzsch M, Leber W, Westphal B, Crusius S, Reisinger EC. Progressive Staphylococcus lugdunensis endocarditis despite antibiotic treatment. Wien Klin Wochenschr 2004; 116:98-101. [PMID: 15008319 DOI: 10.1007/bf03040704] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 68-year old man with fever chills and a diastolic murmur was diagnosed with aortic-valve endocarditis caused by coagulase-negative Staphylococcus lugdunensis. The clinical condition initially improved with antibiotic therapy. On day seven, transoesophageal echocardiography revealed large abscesses extending from the aortic root to the left ventricular wall. Emergency cardiac surgery was performed successfully and a stentless bioprosthetic valve was inserted. S. lugdunensis endocarditis is known for its aggressive clinical course with valve destruction, abscess formation and embolic complications despite appropriate antibiotics. Antibiotic treatment alone is associated with a high mortality rate which can be reduced by early valve replacement.
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Affiliation(s)
- Michael Petzsch
- Division of Cardiology, Department of Medicine, University of Rostock, Rostock, Germany
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26
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Meine TJ, Nettles RE, Anderson DJ, Cabell CH, Corey GR, Sexton DJ, Wang A. Cardiac conduction abnormalities in endocarditis defined by the Duke criteria. Am Heart J 2001; 142:280-5. [PMID: 11479467 DOI: 10.1067/mhj.2001.116964] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac conduction abnormalities occur in endocarditis and have been associated with infection extension and increased mortality. There have been no prospective studies of electrocardiographic (ECG) conduction changes in endocarditis. We examined the incidence of ECG changes in a large prospective cohort with suspected endocarditis and correlated changes with echocardiographic evidence of invasive infection and mortality. METHODS One hundred thirty-seven of 1396 (10%) suspected cases of endocarditis were classified as "definite" or "possible" by the Duke criteria and had an interpretable ECG. ECG conduction changes were classified as old (pre-existing hospitalization), new (evident on admission or developed during hospitalization), or indeterminate. New or indeterminate abnormalities were considered "ECG conduction changes." Echocardiogram results were reviewed to identify infected valves and invasive infection. RESULTS ECG conduction changes were present in 36 of 137 (26%) patients. Patients with ECG conduction changes were more often male (69% vs 46%, P =.005) and had prosthetic valves (47% vs 23%, P <.001). There were no significant differences in microbiology results or treatment with cardiac surgery. In 76 (55%) patients, at least one infected valve was identified by echocardiography; 15 of 76 (20%) patients were determined to have evidence of invasive infection. Eight of 15 (53%) invasive infections exhibited ECG conduction changes compared with 16 of 61 (26%) isolated valve infections (P =.046). Eleven of 36 (31%) patients with ECG conduction changes died during hospitalization compared with 15 of 101 (15%) patients without changes (P =.039). CONCLUSIONS ECG conduction changes commonly occur in endocarditis despite more sensitive diagnostic criteria and are associated with increased mortality and invasive infection.
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Affiliation(s)
- T J Meine
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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27
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Wu YJ, Hong TC, Hou CJ, Chou YS, Tsai CH, Yang DI. Bacillus popilliae endocarditis with prolonged complete heart block. Am J Med Sci 1999; 317:263-5. [PMID: 10210364 DOI: 10.1097/00000441-199904000-00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Bacillus popilliae, a fastidious, aerobic, gram-positive, spore-forming bacillus, has never been reported as a pathogen in human infectious diseases. We report the first case of a human infected by the pathogen B. popilliae, which presented as endocarditis involving the bicuspid aortic valve and complicated with prolonged (> 30 days; to our knowledge, the longest in the literature) complete heart block. Although surgery may be warranted by previous reports, the patient was successfully managed by medical treatment instead, because of the absence of evidence from various approaches that support the existence of perivalvular extension of infection.
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Affiliation(s)
- Y J Wu
- Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China
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28
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Wu YJ, Hong TC, Hou CJY, Chou YS, Cheng-Ho T, Yang DI. Bacillus popilliae Endocarditis with Prolonged Complete Heart Block. Am J Med Sci 1999. [DOI: 10.1016/s0002-9629(15)40518-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 34-1998. A 71-year-old woman with fever, hypotension, and changing cardiac findings. N Engl J Med 1998; 339:1457-65. [PMID: 9841316 DOI: 10.1056/nejm199811123392008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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30
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Abstract
Since early investigators first suggested that the treatment of endocarditis should include valve replacement for infections not readily controlled with medical therapy alone, the role of surgery has become expanded, yet refined, to improve the outcome of patients with this potentially fatal disease. Innovative surgical techniques have also been developed in an effort to improve the results of surgical treatment for complex sequelae of invasive infections. This article examines the current indications for surgical intervention, compares the various surgical options, and assesses the expected short-and long-term outcome after valve replacement for patients with native valve or prosthetic valve endocarditis.
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Affiliation(s)
- M R Moon
- Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, California 94305-5247, USA
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31
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Blumberg EA, Karalis DA, Chandrasekaran K, Wahl JM, Vilaro J, Covalesky VA, Mintz GS. Endocarditis-associated paravalvular abscesses. Do clinical parameters predict the presence of abscess? Chest 1995; 107:898-903. [PMID: 7705150 DOI: 10.1378/chest.107.4.898] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY OBJECTIVE To determine whether standard clinical and transthoracic echocardiographic criteria considered to be suggestive of the presence of endocarditis-associated paravalvular abscess are predictive of which patients would benefit from reliable but invasive transesophageal echocardiographic investigations for abscess. DESIGN Retrospective chart review. SETTING A 630-bed university hospital. PATIENTS Forty-eight patients with 51 episodes of definite endocarditis and 24 paravalvular abscesses. MEASUREMENTS AND RESULTS A comparison of abscess and nonabscess populations revealed that clinical parameters (patient demographics, valvular involvement, presence of a prosthesis, infection with a virulent organism, pericarditis, persistent fever, persistent bacteremia, congestive heart failure, history of intravenous drug use, embolization) and transthoracic echocardiographic parameters were insensitive predictors of the presence of abscess. The only statistically significant correlate was the presence of previously undetected atrioventricular or bundle branch block. Paravalvular abscesses were common in our population and were associated with increased mortality. Improved survival correlated with the absence of mitral valve involvement and the absence of moderate-to-severe congestive heart failure. CONCLUSIONS Given the accuracy and safety of transesophageal echocardiography and the unreliability of clinical and transthoracic echocardiographic criteria, we recommend that transesophageal echocardiography be considered in all endocarditis patients with previously unrecognized conduction disturbances, aortic or prosthetic valve involvement, or both, or indications for valve replacement, or all of the foregoing.
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Affiliation(s)
- E A Blumberg
- Department of Medicine, Hahnemann University, Philadelphia, PA 19102, USA
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32
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Ross BA. Acquired atrioventricular block. PROGRESS IN PEDIATRIC CARDIOLOGY 1994. [DOI: 10.1016/s1058-9813(05)80013-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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33
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al Kasab S, al Fagih M, al Rasheed A, Khan B, Bitar I, Shahed M, Sawyer W. Management of Brucella endocarditis with aortic root abscess. Chest 1990; 98:1532-4. [PMID: 2245705 DOI: 10.1378/chest.98.6.1532] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Three cases of Brucella endocarditis with aortic root abscess are reported. Two patients were successfully managed by a combination of medical therapy and surgery. The third patient died suddenly 36 hours after admission to hospital.
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Affiliation(s)
- S al Kasab
- Riyadh Cardiac Center, Armed Forces Hospital, Saudi Arabia
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34
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Byrd BF, Shelton ME, Wilson BH, Schillig S. Infective perivalvular abscess of the aortic ring: echocardiographic features and clinical course. Am J Cardiol 1990; 66:102-5. [PMID: 2360525 DOI: 10.1016/0002-9149(90)90745-m] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- B F Byrd
- Division of Cardiology, Vanderbilt University School of Medicine, Vanderbilt University Hospital, Nashville, Tennessee 37232
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35
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Weisse AB, Khan MY. The relationship between new cardiac conduction defects and extension of valve infection in native valve endocarditis. Clin Cardiol 1990; 13:337-45. [PMID: 2347125 DOI: 10.1002/clc.4960130507] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
New conduction defects in the setting of native valve infective endocarditis (IE) are commonly believed to be associated with direct extension beyond the free valve area. At University Hospital in Newark, among 100 cases of IE, in none of five instances of associated conduction defects (excluding first-degree heart block) was this the case. In neither of two instances of direct extension of valve infection was this accompanied by a new conduction defect. To explore this relationship, autopsy, surgical, and echocardiographic findings from other institutions were combined with these data. Among 47 instances of new conduction defects in IE, only 60% could be related to direct extension of valve infection. The cause was coronary embolization in 4% and unknown in 36%. Among 119 cases of complicated valve lesions, significant conduction defects were documented by ECG in only 15%. In IE the appearance of new conduction abnormalities may often result from causes other than extension of valve infection. Furthermore, complicated valve lesions may often be present without electrocardiographic evidence, indicating interruption of normal conduction pathways.
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Affiliation(s)
- A B Weisse
- Department of Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark 07103
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36
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Dimitrova NA, Dimitrov GV, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. Effect of electrical stimulus parameters on the development and propagation of action potentials in short excitable fibres. J Am Coll Cardiol 1988; 63:e57-185. [PMID: 2460319 DOI: 10.1016/j.jacc.2014.02.536] [Citation(s) in RCA: 1846] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intracellular action potentials (IAPs) produced by short fibres in response to their electrical stimulation were analysed. IAPs were calculated on the basis of the Hodgkin-Huxley (1952) model by the method described by Joyner et al. (1978). Principal differences were found in processes of activation of short (semilength L less than 5 lambda) and long fibres under near-threshold stimulation. The shorter the fibre, the lower was the threshold value (Ithr). Dependence of the latency on the stimulus strength (Ist) was substantially non-linear and was affected by the fibre length. Both fibre length and stimulus strength influenced the IAP amplitude, the instantaneous propagation velocity (IPV) and the site of the first origin of the IAP (and, consequently, excitability of the short fibre membrane). With L less than or equal to 2 lambda and Ithr less than or equal to Ist less than or equal to 1.1Ithr, IPV could reach either very high values (so that all the fibre membrane fired practically simultaneously) or even negative values. The latter corresponded to the first origin of the propagated IAP, not at the site of stimulation but at the fibre termination or at a midpoint. The characters of all the above dependencies were unchanged irrespective of the manner of approaching threshold (variation of stimulus duration or its strength). Reasons for differences in processes of activation of short and long fibres are discussed in terms of electrical load and latency. Applications of the results to explain an increased jitter, velocity recovery function and velocity-diameter relationship are also discussed.
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Affiliation(s)
- N A Dimitrova
- CLBA, Centre of Biology, Bulgarian Academy of Sciences, Sofia
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37
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Abstract
Management of infective endocarditis includes early recognition of complications and prompt intervention when necessary to avert an untoward result. Among the most serious potential complications of this disorder are those that involve the heart itself. Although the ECG is often normal or nearly so in patients with endocarditis, at other times apparently minor abnormalities may be harbingers of potentially fatal complications. The ECG therefore plays an important role in the initial and ongoing evaluation of patients in whom endocarditis is suspected.
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Affiliation(s)
- W A Berk
- Emergency Department, Detroit Receiving Hospital, MI 48201
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38
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Silver MD, Goldschlager N. Temporary transvenous cardiac pacing in the critical care setting. Chest 1988; 93:607-13. [PMID: 3277806 DOI: 10.1378/chest.93.3.607] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- M D Silver
- Division of Cardiology, San Francisco General Hospital 94110
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39
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DiNubile MJ, Calderwood SB, Steinhaus DM, Karchmer AW. Cardiac conduction abnormalities complicating native valve active infective endocarditis. Am J Cardiol 1986; 58:1213-7. [PMID: 3788810 DOI: 10.1016/0002-9149(86)90384-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Two hundred eleven episodes of native valve active infective endocarditis treated at the Massachusetts General Hospital between 1975 and 1983 were reviewed. The aortic (36%) and mitral (33%) valves were most frequently involved, but in 21% of the cases the site of infection could not be localized. Streptococcal (50%) and staphylococcal (35%) species were the most frequently isolated pathogens. New or changing ("unstable") conduction abnormalities developed in 9% of the patients, while an additional 7% had conduction abnormalities of "indeterminate" age. Unstable conduction block was more likely to develop in patients with aortic valve infective endocarditis than in those with mitral infection. Surgery was performed in 23% of the patients. Unstable conduction abnormalities were significantly associated with valve replacement, but in a multivariate analysis, this effect could be explained by the site of valvular infection. The mortality rate was 20%. Patients with unstable conduction abnormalities had a significantly higher mortality rate, even after other significant predictors of death (age, type of causative organism) were taken into account. Patients whose conduction changes persisted had a worse prognosis than those with transient conduction abnormalities. Although more hemodynamically compromised, patients with unstable conduction block who underwent valve replacement did at least as well as those given medical therapy alone. Patients with native valve active infective endocarditis in whom persistent, unstable conduction abnormalities develop without other identifiable cause, especially in the presence of aortic valve infection, should be considered for valve replacement.
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40
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Feigl D, Feigl A, Edwards JE. Mycotic aneurysms of the aortic root. A pathologic study of 20 cases. Chest 1986; 90:553-7. [PMID: 3757565 DOI: 10.1378/chest.90.4.553] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Twenty specimens of heart with mycotic aneurysms at the aortic root were studied. In ten cases, mycotic aneurysm followed infection of the aortic valve. In one case, it developed following infection of an aortic jet lesion, and in nine patients, the aneurysm was at the seat of a prosthetic aortic valve. In seven of the 11 cases with a natural aortic valve, the valve was either unicuspid or bicuspid. A retrospective evaluation of the data on the clinical records of the 20 patients revealed that infective endocarditis or noncardiac postoperative sepsis was present in 11. The most frequently isolated microorganism was Staphylococcus aureus. Conduction disturbances were found in six patients, all of them with involvement of the atrioventricular node by the aneurysm. Perforation into intracardiac cavities was found in four, two into the right ventricular infundibulum and one each into each atrium. Pericardial tamponade was caused by bleeding from the aneurysm in two cases, and myocardial infarction was a probable consequence of coronary arterial compression by the aneurysm in two cases. Mycotic aneurysms of the aortic root, in spite of their being partially or completely healed of active infection, carry a high risk of the complications enumerated. Among the 20 cases, cultures were positive in 11 and negative in nine. Staphylococcus aureus was cultured from five of the cases.
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41
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Kopelman HA, Graham BS, Forman MB. Myocardial abscess with complete heart block complicating anaerobic infective endocarditis. BRITISH HEART JOURNAL 1986; 56:101-4. [PMID: 3730202 PMCID: PMC1277393 DOI: 10.1136/hrt.56.1.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Myocardial abscess caused by anaerobic infection is rare and usually occurs in cases of myocardial infarction, in which it may be related to areas of low oxygen tension. Bacteroides CDC group F-1 infective endocarditis complicated by an aortic valve ring abscess with resultant complete heart block developed in a patient with steroid dependent systemic lupus erythematosus. The genitourinary system was the presumed source of the infection. Endocarditis developed after an elective abortion, despite antibiotic prophylaxis according to American Heart Association recommendations. This case shows that an anaerobic abscess of the aortic valve ring can affect contiguous vital structures of the conducting system. Immunosuppression may increase the risk of anaerobic infection after genitourinary procedures, and in this situation the recommended antibiotic prophylaxis may be inadequate.
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42
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Ellis SG, Goldstein J, Popp RL. Detection of endocarditis-associated perivalvular abscesses by two-dimensional echocardiography. J Am Coll Cardiol 1985; 5:647-53. [PMID: 3973262 DOI: 10.1016/s0735-1097(85)80390-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The development of a perivalvular abscess as a complication of infective endocarditis adds appreciably to the expected morbidity and mortality of patients, but such abscesses are seldom recognized by available noninvasive techniques. Therefore, two-dimensional echocardiographic findings in 22 patients with perivalvular abscess found at surgery or necropsy were compared with those in 24 patients without abscess in a retrospective but blinded study. Forty-six valves were examined (31 aortic and 15 mitral, 35 prosthetic and 11 native); 4.0 +/- 2.4 days (range 0 to 7) elapsed between echocardiography and surgery or necropsy. Patients with perivalvular abscess had a somewhat higher incidence of serious complications (emergency repeat valve replacement or death) than did patients with endocarditis alone (63 versus 35%, respectively, p less than 0.05). No single echocardiographic finding was frequently seen with a perivalvular abscess. A "typical" echo-free abscess was noted in only one patient; however, the presence of one or more of the following had a positive predictive value of 86% and a negative predictive value of 87% for the presence of perivalvular abscess: prosthetic valve rocking; sinus of Valsalva aneurysm, anterior aortic root thickness of 10 mm or greater, posterior aortic root thickness of 10 mm or greater or perivalvular density in a septum of 14 mm or greater. These predictive values, of course, apply only to patients with infective endocarditis going to surgery, and may assist the surgeon in knowing whether or not to expect an abscess.(ABSTRACT TRUNCATED AT 250 WORDS)
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43
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Dinubile MJ. Heart block during bacterial endocarditis: a review of the literature and guidelines for surgical intervention. Am J Med Sci 1984; 287:30-2. [PMID: 6731477 DOI: 10.1097/00000441-198405000-00010] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The management of patients with bacterial endocarditis complicated by atrioventricular block is based on uncontrolled data, mostly from retrospective surgical and autopsy series. It is difficult to advance broad recommendations on the basis of such a biased population. Nevertheless, it is the firm opinion of many experienced clinicians that heart block developing as the result of aortic endocarditis signals myocardial abscess formation, and thereby is an indication for early surgery. I present a patient with aortic and mitral endocarditis in whom first degree heart block developed and then disappeared over five days; she was successfully managed with medical therapy alone. This case illustrates that some patients with endocarditis and heart block will not require surgery. In this setting, I propose the following guidelines in selecting patients for operation: 1) the observed appearance or progression of heart block; 2) the presence of aortic valve involvement; 3) the persistence of heart block, despite at least one week of optimal antibiotics; and 4) the elimination of other potential causes of conduction abnormalities.
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44
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Dunn HM, McComb JM, Adgey AA. Aortic valve endocarditis complicated by complete heart block. Int J Cardiol 1984; 5:98-101. [PMID: 6693217 DOI: 10.1016/0167-5273(84)90066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A 34-year-old man with severe aortic incompetence caused by Streptococcus viridans developed severe central chest pain followed by complete heart block, multifocal ventricular extrasystoles, lengthening of the QTc and signs of cerebral emboli and pulmonary oedema. Early antibiotic therapy along with pacing, non-invasive investigations coupled with early surgery contributed significantly to the patient's survival.
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45
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46
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47
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Karchmer AW, Dismukes WE, Buckley MJ, Austen WG. Late prosthetic valve endocarditis: clinical features influencing therapy. Am J Med 1978; 64:199-206. [PMID: 629268 DOI: 10.1016/0002-9343(78)90046-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To assess the clinical features which might influence therapy, we studied 43 patients with late prosthetic valve endocarditis (LPVE). Twenty patients (47 per cent) survived. Of patients with streptococcal LPVE 61 per cent (11 of 18) survived compared to 36 per cent (nine of 25) of the patients with nonstreptococcal LPVE (p less than 0.10). Among patients with new regurgitant murmurs 33 per cent (nine of 27) survived versus 69 per cent (11 of 16) with such murmurs (p less than 0.03). Of patients with moderate to severe congestive heart failure (CHF) 16 per cent (three of 19) survived compared to 71 per cent (17 of 24) with mild or no CHF (p less than 0.001). The concurrence of two of these three features, i.e., nonstreptococcal etiology, a new regurgitant murmur or moderate to severe CHF, was associated with a mortality rate of 50 to 90 per cent. Persistent fever during therapy, a regurgitant murmur, atrioventricular conduction disturbances and relapse frequently reflected myocardial invasion. In view of the poor outcome with medical therapy and late reoperation, early surgical intervention should be considered when two of the three features noted are present or when myocardial invasion is suspected.
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48
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Abstract
A case of Escherichia coli septicemia with associated metastatic en dophthalmitis and endocarditis is presented. The ocular signs and symptoms were the initial manifestations of sepsis. Irreversible damage to the eye occurred in less than 24 hours. The pattern of metastatic bacterial endophthalmitis has changed since the introduction of potent antimicrobial agents, with an increased incidence of Gram-negative bacillemia. E. coli endophthalmitis carries a poor prognosis. Early diagnosis and systemic treatment will prevent the life-threatening complications of sepsis.
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49
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Arnett EN, Roberts WC. Active infective endocarditis: a clinicopathologic analysis of 137 necropsy patients. Curr Probl Cardiol 1976; 1:2-76. [PMID: 1026374 DOI: 10.1016/0146-2806(76)90003-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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50
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