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Changing conduction abnormalities in a dialysis patient with fever
Walter Coats1, Anjli Maroo, Tjuan L Overly
1Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Cardiology in Review
|April 22, 2006
Summary
Bedside diagnostic skills are crucial. A hemodialysis patient with aortic valve disease developed new heart rhythm issues, leading to the discovery of a large abscess on the aortic valve.
Area of Science:
- Cardiology
- Infectious Diseases
- Diagnostic Medicine
Background:
- Severe aortic valve disease and arteriovenous fistula infection are significant clinical concerns in hemodialysis patients.
- Cardiac arrhythmias and conduction abnormalities can indicate serious underlying cardiac pathology.
Observation:
- A patient undergoing hemodialysis presented with new-onset atrial fibrillation and alternating bundle branch blocks on electrocardiograms.
- These electrocardiographic changes were observed in the context of severe aortic valve disease and suspected arteriovenous fistula infection.
Findings:
- Transesophageal echocardiography revealed a large abscess within the intervalvular fibrosa and posterior cusp of a bicuspid aortic valve.
- The abscess was linked to the patient's cardiac presentation and underlying conditions.
Implications:
- This case underscores the continued importance of fundamental bedside diagnostic skills in identifying critical cardiac conditions.
- Even with advanced imaging and laboratory tests, clinical acumen is vital for accurate diagnosis and patient management.
- Highlights the potential for serious cardiac complications in hemodialysis patients with valvular disease and infection.
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