INFECTIVE ENDOCARDITIS PRESENTING AS COMPLETE HEART BLOCK

Abstract Background Right-sided tricuspid valve (TV) endocarditis can be difficult to identify and may be under-recognized in the absence of traditional risk factors. While generally identified with aortic valve pathology, infective endocarditis that extends beyond the leaflets of the TV have been reported to cause conduction disease. Case summary We present the case of a 63-year-old patient who presented with haemodynamically unstable complete heart block requiring temporary venous pacemaker support. Despite the absence of traditional risk factors or significant valvular disease on transthoracic echocardiogram, she was found to be persistently bacteraemic and subsequent transoesophageal echocardiogram identified large vegetation on the septal leaflet of the TV. Conduction disease was noted to reverse with antibiotic therapy and resolution of bacteraemia. Discussion Although rare, right-sided endocarditis involving the triangle of Koch may present with conduction disease due to local inflammation and mechanical compression. Conduction disease associated with right-sided disease appears to be readily reversible with medical therapy and temporary device support may be appropriate in the acute setting.

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Blocking a rash diagnosis: a rare case of infective endocarditis

BMJ Case Reports ◽

10.1136/bcr-2018-226213 ◽

2019 ◽

Vol 12 (3) ◽

pp. e226213

Author(s):

Brittne Halford ◽

Mariah Barstow Piazza ◽

Haley Berka ◽

Caitlin Taylor

Keyword(s):

Renal Failure ◽

Infective Endocarditis ◽

Heart Block ◽

Rare Case ◽

Complete Heart Block ◽

Normal Component ◽

Blood Cultures ◽

Oral Flora ◽

Pacemaker Placement ◽

Granulicatella Adiacens

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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AORTO-CAVITARY FISTULA WITH CO-EXISTING COMPLETE HEART BLOCK AS A COMPLICATION OF INFECTIVE ENDOCARDITIS

CHEST Journal ◽

10.1016/j.chest.2019.08.707 ◽

2019 ◽

Vol 156 (4) ◽

pp. A734

Author(s):

Vishal Deepak ◽

Mehdi Farishta ◽

Anandbir Bath ◽

Jasreen Kaur

Keyword(s):

Infective Endocarditis ◽

Heart Block ◽

Complete Heart Block

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Pediatric Tricuspid Valve Infective Endocarditis- Insite into a challenging management

10.22541/au.160777045.55267034/v1 ◽

2020 ◽

Author(s):

Amitabh Satsangi ◽

DHARAMRAJ SINGH

Keyword(s):

Infective Endocarditis ◽

Ventricular Septal Defect ◽

Tricuspid Valve ◽

Heart Block ◽

Septal Defect ◽

Surgical Intervention ◽

Complete Heart Block ◽

Heart Defects ◽

Diagnostic Methods ◽

Tricuspid Valve Endocarditis

:Pediatric tricuspid vavle endocarditis is an uncommon entity which is now becoming prevalent oweing to improved diagnostic methods and increase number of cardiac surgeries.Paediatric right sided infective endocarditis are mostly secondary to structural heart defects or indwelling venous catheters .We present a case of paeditric tricuspid valve endocarditis presenting with complete heart block,septic arthritis, pulmonary abcess with no structural heart defect diagnosted preoperatively.Intra-operatively a ventricular septal defect was diagnosed and managed .We present the difficult management of the case by medical and surgical intervention and management of secondary fungal infective endocarditis with repeated successful surgical intervention . We also emphasize on lack of established guidelines for management of right -sided infective endocarditis.

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Native Valve Endocarditis due toRalstonia pickettii: A Case Report and Literature Review

Case Reports in Infectious Diseases ◽

10.1155/2015/324675 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9

Author(s):

Joseph Orme ◽

Tomas Rivera-Bonilla ◽

Akil Loli ◽

Negin N. Blattman

Keyword(s):

Case Report ◽

Infective Endocarditis ◽

Aortic Valve ◽

Literature Review ◽

Heart Block ◽

Complete Heart Block ◽

Healthy Individuals ◽

Native Valve ◽

Native Valve Endocarditis ◽

First Case

Ralstonia pickettiiis a rare pathogen and even more rare in healthy individuals. Here we report a case ofR. pickettiibacteremia leading to aortic valve abscess and complete heart block. To our knowledge this is the first case report ofRalstoniaspecies causing infective endocarditis with perivalvular abscess.

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Outcomes of surgically treated infective endocarditis in a Western Australian population

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01727-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Aditya Eranki ◽

Ashley R. Wilson-Smith ◽

Umar Ali ◽

Akshat Saxena ◽

Eric Slimani

Keyword(s):

Cardiopulmonary Bypass ◽

Infective Endocarditis ◽

Heart Block ◽

Complete Heart Block ◽

Univariate Analysis ◽

Morbidity And Mortality ◽

High Morbidity ◽

Australian Population ◽

Valvular Surgery ◽

Western Australian

Abstract Background Infective endocarditis is a disease that carries high morbidity and mortality. The primary endpoint of this study is to assess factors associated with in-hospital mortality in patients undergoing valvular surgery for infective endocarditis. The secondary endpoint of this study is to assess the incidence of post-operative stroke, renal failure, complete heart block and recurrence. Methods Between the years of 2015 to 2019, a total of 89 patients underwent surgery for infective endocarditis at Fiona Stanley Hospital, Western Australia. Data was collected from the Australia and New Zealand Cardiac Surgery Database from 2015 to 2019 as well as patients electronic medical record. A number of preoperative and perioperative factors were assessed in relation to patient mortality and morbidity. Univariate and multivariate logistical regression analysis was done to assess for the association between factors and in-hospital morbidity and mortality. Results A total of 89 patients underwent surgery for infective endocarditis from 2015 to 2019, affecting a total of 101 valves. The mean age of patients was 53.7 ± 16.5. A total of 79 patients had a positive blood culture pre-operatively, with Staphylococcus Aureus being the most frequently cultured organism (39%). Fourteen patients (16%) were deemed emergent and underwent surgery within 24 h of review. A total of five patients died within their hospital stay postoperatively. Variables significantly associated with mortality on univariate analysis were intravenous drug use, emergent surgery, perioperative dialysis, perioperative inotropes, cardiopulmonary bypass time and cross clamp time. Only CBP time was significantly associated with mortality on multivariate analysis. A total of 19 patients (21%) required hemodialysis after surgery, 10 patients sustained a postoperative stroke (11%), 11 patients developed a complete heart block post operatively (12%) and endocarditis recurred in 10 patients (11%). Conclusion Prolonged cardiopulmonary bypass times were significantly associated with mortality. This study is novel to report a lower mortality rate than previously quoted in the literature. We also report our findings of organisms, preoperative embolic phenomena and surgery in a Western Australian population. We recommend that all patients with endocarditis are discussed in multidisciplinary forum.

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