Pseudoaneurysm of the Left Ventricte as a Complication of Septic Embolism

Bs, Joergensen; Ladegaard, Lars; Szczepański, Cezary

doi:10.1055/s-2007-1022151

Cited by 4 publications

(1 citation statement)

References 4 publications

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“…Our patient was stable and the diagnosis was made by a “routine echocardiogram”. The mechanism of rupture with infective endocarditis is caused by either septic embolisation of aortic valve vegetations resulting in a mycotic abscess, or myocardial infarction 3. Spread of infection to the surrounding myocardium and rupture of an abscess remote from the affected valve have been reported 7…”

Section: Discussionmentioning

confidence: 99%

Cardiac rupture caused by Staphylococcus aureus septicaemia and pericarditis: an incidental finding

Osula¹,

Lowe²,

Perry³

2001

Heart

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A 35 year old woman with a long history of intravenous drug abuse presented to a local hospital with severe anaemia, fever, raised markers of inflammation, and positive blood cultures for Staphylococcus aureus. She responded to treatment with antibiotics with improvement in her symptoms and markers of inflammation. Four weeks later a "routine" echocardiogram showed a rupture of her left ventricular apex and a large pseudoaneurysm. There had been no deterioration in her symptoms or haemodynamic status to herald this new development. It was successfully repaired surgically and the patient made a good recovery. (Heart 2001;85:e4) Keywords: ventricular rupture; pseudoaneurysm; staphylococcal septicaemia Cardiac rupture and pseudoaneurysm of the left ventricular free wall is a well recognised complication of myocardial infarction, cardiac trauma or cardiac surgery.1 2 There are a few reported associations with endocarditis, septicaemia or tumour infiltration.3-6 These reported cases are all associated with a sudden or progressive haemodynamic deterioration. We report a case of cardiac rupture and pseudoaneurysm of the left ventricular free wall found on "routine" echocardiography in a patient with Staphylococcus aureus septicaemia. Case reportA 35 year old female intravenous drug abuser was referred to a local hospital with a three week history of malaise, lethargy, and weight loss. She had lost 10 kg in three weeks and complained of left sided pleuritic chest pains.She had a long history of intravenous drug misuse and had been on a methadone withdrawal programme for two months, although she admitted to the concomitant use of heroine. In 1992 and 1997 she was admitted to the same hospital with a left proximal deep vein thrombosis and right groin abscess respectively caused by injecting heroin into her femoral vein. A systolic murmur had been heard and an echocardiogram booked, but she had defaulted.On examination she looked ill and had a low grade pyrexia. She had a tachycardia of 100 beats/min but was normotensive. There were no cutaneous stigmata of endocarditis and the only positive finding was a systolic murmur suggestive of mitral regurgitation.Investigations revealed a microcytic anaemia with a haemoglobin of 3.5 mmol/l (5.7 g/d1) and a white cell count of 10.7 × 10 9 /l. Inflammatory markers were raised (C reactive protein 130 mg/l and erythrocyte sedimentation rate 54 mm/hour), and two sets of blood cultures grew S aureus. Her chest x ray was normal. The ECG showed non-specific T wave inversion aVecting the inferiolateral leads. Her echocardiogram revealed normal left ventricular systolic function and a left ventricular band near the apex. There was mild mitral and tricuspid regurgitation but no vegetations were seen. The aortic valve was normal. A small pericardial eVusion was noted. A diagnosis of bacterial endocarditis was made and she was treated with appropriate antibiotics (flucloxacillin and gentamicin) and given a transfusion of 4 units of blood. Her temperature settled and markers of infla...

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Section: Discussionmentioning

confidence: 99%

Cardiac rupture caused by Staphylococcus aureus septicaemia and pericarditis: an incidental finding

Osula¹,

Lowe²,

Perry³

2001

Heart

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Bacterial endocarditis presenting as acute myocardial infarction: a cautionary note for the era of reperfusion

Herzog

Henry

Zimmer

1991

The American Journal of Medicine

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Coronary embolism is a known complication of bacterial endocarditis that sometimes causes acute myocardial infarction. The necessity for rapidly restoring coronary artery perfusion and the time constraints governing clinical decisions may prevent endocarditis from being diagnosed before pharmacologic or mechanical thrombolysis. This report describes the first documented cases of coronary angioplasty in two patients with acute myocardial infarction caused by bacterial endocarditis, and reviews the literature on coronary artery complications of bacterial endocarditis. The first patient developed a coronary artery mycotic aneurysm at the dilatation site; the second experienced a small intracerebral hemorrhage following reperfusion. It is, of course, unwise to generalize from two cases, but we believe that in patients who are most likely to have endocarditis as the cause of acute myocardial infarction, the impulse to follow conventional strategies for coronary reperfusion should be tempered by thoughts of possible consequences.

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Bacterial endocarditis presenting as acute myocardial infarction: A cautionary note for the era of reperfusion

Herzog¹,

Henry²,

Zimmer³

1991

The American Journal of Medicine

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Pseudoaneurysm of the Left Ventricte as a Complication of Septic Embolism

Cited by 4 publications

References 4 publications

Cardiac rupture caused by Staphylococcus aureus septicaemia and pericarditis: an incidental finding

Cardiac rupture caused by Staphylococcus aureus septicaemia and pericarditis: an incidental finding

Bacterial endocarditis presenting as acute myocardial infarction: a cautionary note for the era of reperfusion

Bacterial endocarditis presenting as acute myocardial infarction: A cautionary note for the era of reperfusion

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