Is a Negative Transesophageal Echocardiogram Enough to Stop Treatment?

Faroqui, Mouzamjha; Shariff, Amal

doi:10.1016/j.chest.2017.08.072

Cited by 2 publications

(1 citation statement)

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“…Furthermore, delayed or inadequate antimicrobial therapy is associated with overall greater in-hospital mortality rates in patients with IE [ 7 ] and some studies have shown significant reductions in the risk of stroke related to IE after the initiation of appropriate antimicrobial therapy [ 2 ]. Thus, a negative transesophageal echocardiogram result should not delay the initiation of antimicrobial therapy if clinical suspicion of endocarditis remains high [ 8 ]. Repeating TEE 7-14 days after the initial negative result may reveal vegetations that were missed on the initial exam [ 3 ], better characterize complications such as perivalvular abscess, and further guide management [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Recurrent Embolic Strokes From Prosthetic Valve Endocarditis With Negative Initial Evaluation in a Non-Toxic-Appearing Patient: A Case Report

Karazanashvili¹,

Williams²

2022

Cureus

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Infective endocarditis (IE) is a common cause of embolic strokes. Early diagnosis and treatment are essential to decrease the risk of ischemic stroke and ensure appropriate treatment, particularly given the higher risk of hemorrhagic complications. Treatment is also essential to prevent other complications such as heart failure, perivalvular abscesses, or intracranial abscesses. Transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) may not show endocardial involvement in the early stages of IE and, rarely, some patients may lack systemic signs of infection, making the early detection of IE challenging. Multifocal ischemic strokes may be the initial manifestation of IE and warrant further workup directed at IE even if initial echocardiogram findings are negative. A high index of clinical suspicion and thorough history are of utmost importance.

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Section: Discussionmentioning

confidence: 99%

Recurrent Embolic Strokes From Prosthetic Valve Endocarditis With Negative Initial Evaluation in a Non-Toxic-Appearing Patient: A Case Report

Karazanashvili¹,

Williams²

2022

Cureus

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Papillary Muscle Rupture in the Setting of Streptococcus lutetiensis Endocarditis

Leker,

Patel,

Zahid

2024

Journal of Investigative Medicine High Impact Case Reports

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Papillary muscle rupture is commonly linked to ischemic events, occurring typically postmyocardial infarction. However, iatrogenic and nonischemic etiologies can play a role in papillary muscle rupture, including infective endocarditis. The case presented herein is an 85-year-old female with a history of heart failure with preserved ejection fraction (HFpEF), who presented with progressive dyspnea despite furosemide therapy, and was discovered to have a flail posterior mitral valve leaflet secondary to papillary muscle rupture associated with Streptococcus lutetiensis endocarditis. Transthoracic echocardiography revealed flail posterior mitral valve leaflet with newly appreciated severe wide-open mitral regurgitation. Emergent mitral valve repair was performed with a successful MitraClip placement. Patient had an atypical presentation without ischemic symptomology or electrocardiogram (EKG) changes indicative of ischemia. Despite transesophageal echocardiography, not revealing vegetations, infective endocarditis was presumed due to presence of Streptococcus lutetiensis bacteremia, osteomyelitis, elevated inflammatory markers, and clinical presentation. Papillary muscle rupture results in severe mitral regurgitation that is a medical emergency that requires prompt diagnosis and management from a multidisciplinary team. Therefore, it is imperative to ensure clinical insight into the multiple etiologies of papillary muscle rupture to provide timely treatment.

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Is a Negative Transesophageal Echocardiogram Enough to Stop Treatment?

Cited by 2 publications

References 0 publications

Recurrent Embolic Strokes From Prosthetic Valve Endocarditis With Negative Initial Evaluation in a Non-Toxic-Appearing Patient: A Case Report

Recurrent Embolic Strokes From Prosthetic Valve Endocarditis With Negative Initial Evaluation in a Non-Toxic-Appearing Patient: A Case Report

Papillary Muscle Rupture in the Setting of Streptococcus lutetiensis Endocarditis

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