scholarly journals Torsades de Pointes in Intravenous Drug Abuse–Associated Infective Endocarditis

2018 ◽  
Vol 21 (6) ◽  
pp. E507-E512
Author(s):  
Sarah Eapen ◽  
Michael Firstenberg
Keyword(s):  
Drug Abuse ◽  
Infective Endocarditis ◽  
Tricuspid Valve ◽  
Drug Overdose ◽  
Heart Block ◽  
Torsades De Pointes ◽  
Conduction System ◽  
Intravenous Drug ◽  
Intravenous Drug Abuse ◽  
Tricuspid Valve Replacement

Intravenous drug abuse rates in the United States have increased exponentially in recent years. Ohio is one of 5 states with the highest age-adjusted drug overdose death rates, with drug overdose causing 39.1 of every 100,000 deaths. In patients who survive, the associated morbidity poses a significant public health burden. Infective endocarditis, defined as an infection of the endocardium of the heart, is a potentially lethal consequence of bacteremia related to intravenous drug abuse. Methicillin-sensitive Staphylococcus aureus (MSSA) is the most commonly implicated organism and may affect the tricuspid valve. Indications for surgery include failure of medical management, worsening embolization, heart failure, and arrhythmias—typically bradyarrhythmias from infectious extension into the conduction system. Vegetation size and type of infection, such as drug-resistance pattern, fungal infection, and presence of prosthetic material, are becoming known risk factors for complications. Studies have demonstrated that early surgery tends to have a better prognosis than delayed intervention. Established guidelines for right-sided surgery are slowly evolving. Tricuspid valve surgery is becoming more common in these cases, but there is known risk for heart block owing to proximity of the conduction system to the tricuspid valve annulus. If patients develop complete heart block postoperatively, pacemaker placement may be indicated. There may be reluctance to implantation because of the risk of device infection with infective endocarditis. In addition, many may recover conduction as infection and edema resolve. Generally, bradyarrhythmias are well tolerated. However, we present 2 cases of torsades de pointes related to post-tricuspid-valve-replacement bradyarrhythmia. Torsades de pointes is a potentially lethal form of polymorphic ventricular arrhythmia associated with QT interval prolongation. Post-tricuspid-valve- replacement mortality may be secondary to induced lethal ventricular arrhythmias.

scholarly journals Tricuspid valve infective endocarditis following intravenous administration of traditional and complementary medicine (T&CM)

2020 ◽  
pp. 201010582093957
Author(s):  
Raja Ezman Raja Shariff ◽  
Sazzli Kasim ◽  
Effarezan Abdul Rahman
Keyword(s):  
Drug Abuse ◽  
Infective Endocarditis ◽  
Complementary Medicine ◽  
Tricuspid Valve ◽  
Intravenous Administration ◽  
Intravenous Drug ◽  
Intravenous Drug Abuse ◽  
Rare Occurrence ◽  
Device Implantation ◽  
Healthcare Associated

Right-sided infective endocarditis (IE) is often linked to intravenous drug abuse and healthcare-associated procedures involving catheters and device implantation. We report a rare occurrence of right-sided IE secondary to intravenous use of traditional and complementary medicine (T&CM).

Clinical outcomes of severe tricuspid valve infective endocarditis related to intravenous drug abuse – a case series

2021 ◽  
pp. 1-6
Author(s):  
Cheryl Zhiya Chong ◽  
Robin Cherian ◽  
Perryn Ng ◽  
Tiong Cheng Yeo ◽  
Lieng Hsi Ling ◽  
...  
Keyword(s):  
Drug Abuse ◽  
Infective Endocarditis ◽  
Clinical Outcomes ◽  
Tricuspid Valve ◽  
Case Series ◽  
Intravenous Drug ◽  
Intravenous Drug Abuse

scholarly journals Surgical treatment of infective endocarditis in intravenous drug abusers

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Alina Zubarevich ◽  
Marcin Szczechowicz ◽  
Anja Osswald ◽  
Jerry Easo ◽  
Arian Arjomandi Rad ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Drug Abuse ◽  
Infective Endocarditis ◽  
Mortality Rates ◽  
Blood Cultures ◽  
Intravenous Drug ◽  
Intravenous Drug Abuse ◽  
Enterococcus Species ◽  
Function Impairment

Abstract Background Despite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients. Methods Between 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years. Results Staphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis. Conclusion In patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.

Infective Endocarditis Due to Neisseria sicca and Associated With Intravenous Drug Abuse

1992 ◽  
Vol 85 (9) ◽  
pp. 929 ◽  
Author(s):  
GREGG A. VALENZUELA ◽  
THOMAS D. DAVIS ◽  
EDDY PIZZANI ◽  
DAVID MCGROARTY
Keyword(s):  
Drug Abuse ◽  
Infective Endocarditis ◽  
Intravenous Drug ◽  
Intravenous Drug Abuse ◽  
Neisseria Sicca

scholarly journals A Complicated Case ofSerratia marcescensInfective Endocarditis in the Era of the Current Opioid Epidemic

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Ho-Man Yeung ◽  
Brijaé Chavarria ◽  
Dariush Shahsavari
Keyword(s):  
Drug Abuse ◽  
Infective Endocarditis ◽  
Intravenous Drug ◽  
Intravenous Drug Abuse ◽  
Course Of Disease ◽  
Septic Emboli ◽  
Severe Aortic Regurgitation ◽  
History Of ◽  
Pain Symptoms ◽  
Complicated Nature

While bacteremia due toSerratia marcescensis not uncommon, it rarely causes infective endocarditis. We report an isolated case of a 53-year-old male with history of intravenous drug abuse who presented with multiple acute pain symptoms and was found to haveS. marcescensbacteremia with septic emboli in his spleen, brain, and testes, secondary to a large aortic vegetation, as well as aortic infective endocarditis with severe aortic regurgitation requiring aortic valve replacement. His course of disease was further complicated by epidural and psoas abscesses and a necrotic testicle requiring orchiectomy due to his ongoing intravenous drug abuse. This case is an atypical presentation ofS. marcescensinfection, as he had no overt signs of infection such as fever or significant leukocytosis that are typical of bacteremia, and it also highlights the severity and complicated nature ofS. marcescens-infective endocarditis.

scholarly journals Intraveninių narkomanų triburio vožtuvo izoliuoto infekcinio endokardito chirurginio gydymo patirtis

2010 ◽  
Vol 8 (3) ◽  
pp. 0-0
Author(s):  
Gediminas Džiugas ◽  
Kęstutis Ručinskas ◽  
Palmyra Semėnienė ◽  
Karolina Džiugienė ◽  
Arimantas Grebelis ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Valve Replacement ◽  
Tricuspid Valve ◽  
Drug Users ◽  
Intravenous Drug ◽  
Drug Abusers ◽  
Tricuspid Valve Replacement ◽  
Valve Reconstruction ◽  
Intravenous Drug Abusers ◽  
Tricuspid Valve Reconstruction

Gediminas Džiugas1, Kęstutis Ručinskas1 , Palmyra Semėnienė1, Karolina Džiugienė2, ArimantasGrebelis1, Vytautas Sirvydis1 1 Vilniaus universiteto Širdies ir kraujagyslių ligų klinika, Santariškių g. 2, LT-08661 VilniusEl. paštas: [email protected] Vilniaus universiteto Medicinos fakultetas Įvadas: Mažiausiai 5 % triburio vožtuvo (TV) infekcinio endokardito (IE) atvejų reikia gydyti chirurgiškai. Nėra daug studijų, analizuojančių intraveninių narkomanų izoliuoto triburio vožtuvo infekcinio endokardito chirurginio gydymo rezultatus. Duomenų apie tokių ligonių gydymą Lietuvoje nėra. Mes pateikiame pastarųjų 10-ies metų rezultatus, gydant intraveninius narkomanus, operuotus dėl triburio vožtuvo infekcinio endokardito. Įvertinome triburio vožtuvo protezavimo biologiniu vožtuvu ir plastikos ankstyvuosius bei vėlyvuosius rezultatus. Ligoniai ir metodai: Ši studija retrospektyvi. Atlikta 18 ligonių, operuotų Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centre dėl izoliuoto triburio vožtuvo infekcinio endokardito 2000–2010 m., duomenų analizė. Visi ligoniai vartojo intraveninius narkotikus. Rezultatai: Pooperaciniu laikotarpiu nemirė nė vienas ligonis, visi išrašyti iš stacionaro. Ankstyvųjų pooperacinių komplikacijų pasitaikė tik ligoniams, kuriems atliktas triburio vožtuvo protezavimas (4 iš 14 pacientų). Tačiau skirtumas, palyginti su triburio vožtuvo plastikos grupe, nereikšmingas (p=0,225). Ilgesnė hospitalizacijos trukmė buvo po TV protezavimo biologiniu protezu (27,7±14,5 d.) nei po TV plastikos (18,7±15,1 d.). Vėlyvosios komplikacijos išsivystė 8 ligoniams: septyniems buvo atliktas pirminis TV protezavimas biologiniu vožtuvu ir vienam – TV plastika. Keturiems ligoniams buvo infekcinio endokardito atkrytis. Vėlyvuoju pooperaciniu laikotarpiu mirė 4 (22 %) ligoniai. Išvados: Daliai intraveninių narkomanų triburio vožtuvo chirurginė korekcija yra vienintelis veiksmingas triburio vožtuvo infekcinio endokardito gydymo būdas. Po triburio vožtuvo protezavimo biologiniu protezu dažnai būna ankstyvųjų ir vėlyvųjų komplikacijų. Triburio vožtuvo plastika – saugesnis gydymo būdas ankstyvuoju pooperaciniu laikotarpiu. Reikšminiai žodžiai: triburis vožtuvas, intraveninių narkotikų vartojimas, infekcinis endokarditas, triburio vožtuvo plastika, triburio vožtuvo protezavimas, komplikacijos The experience of surgery for isolated tricuspid valve infective endocarditis in intravenous drug abusers Gediminas Džiugas1, Kęstutis Ručinskas1 , Palmyra Semėnienė1, Karolina Džiugienė2, ArimantasGrebelis1, Vytautas Sirvydis1 1 Vilniaus universiteto Širdies ir kraujagyslių ligų klinika, Santariškių g. 2, LT-08661 VilniusEl. paštas: [email protected] Vilniaus universiteto Medicinos fakultetas Objective: Tricuspid valve infective endocarditis usually affects intravenous drug users. At least 5% of patients with tricuspid valve infective endocarditis have to be treated surgically. Few data exist on surgery for the isolated tricuspid valve infective endocarditis in intravenous drug abusers, and there is no such data in Lithuania. This study summarizes our experience in a surgical treatment of isolated tricuspid valve infective endocarditis in intravenous drug users. Patients and methods: This is a retrospective analysis of 18 patients operated on for isolated tricuspid valve infective endocarditis in our centre in 2000–2010. All the patients were intravenous drug abusers. Results: There were no perioperative deaths. Early complications were observed only in the tricuspid valve replacement group (4/14), but there was no significant difference (p = 0.225) was compared to the reconstruction group. There was a longer hospitalization period (27.7 ± 14.5 d) for tricuspid valve replacement than for tricuspid valve reconstruction (18.7 ± 15.1 d.). Eight patients had late complications, of them seven had undergone initial tricuspid valve replacement and one – reconstruction. Four patients had recurrent endocarditis. Late mortality was in 4 (22 %) patients. Conclusion: For some intravenous drug abusers, tricuspid valve surgery for tricuspid valve infective endocarditis is the only effective treatment. Tricuspid valve replacement with biological prosthesis for intravenous drug abusers is associated with numerous early and late postoperative complications. Tricuspid valve reconstruction is a safe method of treatment in the early postoperative period. Key words: tricuspid valve, intravenous drug abusers, infective endocarditis, tricuspid valve reconstruction, tricuspid valve replacement, complications.

scholarly journals Tricuspid Valve Infective Endocarditis In Drug Abusers: Clinical Features and Results of Surgical Treatment

2013 ◽  
Vol 7 (1) ◽  
pp. 29-34
Author(s):  
DI Lashmanov ◽  
Krishna Bhandari ◽  
VA Chiginev ◽  
VV Pichugin ◽  
EN Zemskova
Keyword(s):  
Surgical Treatment ◽  
Drug Abuse ◽  
Infective Endocarditis ◽  
Valve Replacement ◽  
Clinical Features ◽  
Tricuspid Valve ◽  
Prosthetic Valve ◽  
Drug Abusers ◽  
Tricuspid Valve Replacement ◽  
Ultrasound Investigation

The objective of this study was to evaluate the clinical features, diagnostic criteria and indications for surgery in patients – drug abusers with tricuspid valve infective endocarditis (TVIE), and outcome of surgical treatment in these patients. From December 1999 to August 2009 35 patients (drug addicts) with TVIE were operated in the department of acquired heart diseases of Cardiac and Vascular Surgery Center, Nizhny Novgorod. 25 males and 10 females aged from 15 to 51 years were included in this study. 3 patients were re-operated due to recurrence of endocarditis. Biological prosthetic valve "Bio-Lab" was used in all patients. Intravenous drug abuse was the cause of the disease in all patients. Acute onset with hectic fever, shivering, profuse sweating, intoxication and development of multi-organ failure were the main clinical features of the disease. Embolism of the peripheral branches of pulmonary artery by septic embolus or micro thrombi were common symptoms. Ultrasound investigation played an important role in diagnosis of TVIE. It was the only criteria for the verification of the diagnosis in patients with fever of unknown origin until the appearance of valve damages and cardiac murmurs. All 35 (100%) patients underwent tricuspid valve replacement (TVR). 3 (8.57%) patients underwent redo TVR because of prosthetic valve endocarditis due to persistent intravenous drug abuse after surgery. The hospital mortality rate was 0%. Acute debut of the disease may be the first clinical feature of tricuspid valve infec­tive endocarditis in drug abusers. Ultrasound investigation is important for early diagnosis and effective treatment. Surgical treatment is indicated in cases of ineffective antibiotic therapy and massive tricuspid valve damages. Tricuspid valve replacement by a biological prosthesis was the treatment of choice in these patients. The use of biological prosthetic valve had good clinical re­sults with low thrombogenic risk and high resistance to infection. Nepalese Heart Journal | Volume 7 | No.1 | November 2010 (special issue) | Page 29-34 DOI: http://dx.doi.org/10.3126/njh.v7i1.8499

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