A Case Report of Acute Heart Failure Due to Infective Aortic Endocarditis Diagnosed by Point-of-care Ultrasound

Abstract

Introduction: Infective endocarditis (IE) is a life-threatening condition with significant morbidity and mortality, and can require surgical repair. Case Report: A 36-year-old man presented to the emergency department for worsening dyspnea and chest pain. Point-of-care echocardiography demonstrated a mobile oscillating mass on the aortic valve with poor approximation of the valve leaflets, suggesting aortic valve insufficiency secondary to IE as the cause of acute heart failure. The patient underwent emergent aortic valve replacement within 24 hours. Discussion: While point-of-care echocardiography has been well documented in identifying tricuspid vegetations, aortic valve involvement and subsequent heart failure is less well described. Earlier recognition of aortic valve vegetations and insufficiency can expedite surgical intervention, with decreased complication rates linked to earlier antimicrobial therapy. Conclusion: This case report highlights the ability of point-of-care ultrasound to identify aortic vegetations, allowing for the earlier diagnosis and therapy.

Bedside Echocardiography Diagnosis of Tricuspid Valve Infective Endocarditis in the Emergency Department

“…One of the major elements in the Duke criteria comprises a positive echocardiogram for IE, which is defined as either the presence of an intra-cardiac mass or abscess on valves or supporting structures, new or acute worsening of valvular regurgitation, or new disruption of a prosthetic valve [1][2][3]. Hence, it is imperative that EPs recognize the potential advantages of implementing an initial bedside ultrasound evaluation in cases when there is clinical concern for IE [8][9][10][11][12][13][14][15]. The diagnostic performance of TTE for IE has been reported with a sensitivity of 61% and a specificity of 94% [1][2][3]6,7].…”

“…Transthoracic echocardiography (TTE) is an invaluable initial diagnostic tool for the emergency physician (EP) to rapidly identify IE [ 1 - 4 , 6 , 7 ]. Bedside focused cardiac ultrasound (FOCUS) with EP-performed TTE has previously been shown to be vital for the timely diagnosis of suspected IE [ 8 - 15 ]. This report illustrates the decisive role of EP-performed FOCUS to facilitate the early ED diagnosis and management of right-sided IE notably complicated with SPE.…”

Aortic regurgitation: epidemiologic, etiologic, and pathophysiologic characteristics

“…Среди основных причин острой АР выделяют повреждения АК в результате травм [27], оперативных вмешательств [28], включая процедуры на клапане, выполненные катетерным способом [29], и осложнений инфекционного эндокардита [30]. Хроническая АР имеет намного больше причин и, кроме инфекционного эндокардита, ревматической болезни сердца [11,31] и системных заболеваний соединительной ткани [32], ответственных также и за поражение МК, развивается при дегенеративных изменениях АК (фиброкальциноз) [33,34], сифилисе [35], спондилоартритах (анкилозирующем спондилите (АСп)) [36], псориатическом [37] и реактивном артритах [38]), васкулитах с поражением артерий крупного калибра (неспецифический аортоартериит [39], гигантоклеточный артериит [40], болезнь Бехчета [41]).…”