An Autopsied Case of Infective Endocarditis with Cardiac Tamponade due to Myocardial Rupture

Abstract

Since it is very rare that cardiac tamponade due to myocardial rupture caused by infective endocarditis, occurs we are reporting this case. A 62 year old man, who had underlying diseases of pneumoconiosis and hypertensive heart disease, visited Chikuho Rosai Hospital complaining of chest oppression and general fatigue on Feb. 7, 1987. He was diagnosed as having ischemic heart disease by electrocardiogram. Two days later, he suddenly had chills and a fever, and the laboratory data showed leukocytosis and a positive C-reactive protein (CRP). The echo cardiogram showed mitral regurgitation (MR) and aortic regurgitation (AR), but neither vegetation nor pericardial effusion was observed. On Feb. 16, he was admitted with shock, and he died the next day. The blood cultures grew gram-positive cocci, respectively. From the clinical symptoms, chest roentgenogram and electrocardiogram, we suspected a cardiac tamponade. On autopsy findings, though coronary arteries were intact, the aortic valves had severe valvular adhesions, calcifications and hypertrophies. The rupture hole was observed in the left ventricles, which was just under the aortic valve through the pericardiac space. It seemed that he died of a cardiac tamponade due to the outflow of blood from this hole. On histopathologic findings of the cardiac wall, gram-positive cocci and many of neutrophils were observed.

Cardiac Tamponade as an Unusual Manifestation of Infective Endocarditis

“…In general, cardiac rupture is rapidly fatal without surgery 4,5 . If the rupture is small and the pericardium intact, the hemopericardium that develops may tamponade the bleeding.…”

“…Multiple cases of death caused by rupture of a myocardial abscess associated with infective endocarditis have been reported, 4,5 but survival after perforation of the left ventricle wall due to a contained rupture is very rare. Only four cases have been published 1,6‐8 .…”