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Published on: September 24, 2021
Infective Endocarditis Presenting as Complete Heart Block With an Unexpected Finding of a Cardiac Abscess and
Randolph E Brown1, John Michael Chua Chiaco1, Jessica L Dillon2
1Department of Cardiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
Insights
Infective endocarditis can rarely cause an intracardiac abscess leading to complete heart block. This case highlights the critical need for prompt intervention in such severe presentations.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- Infective endocarditis typically affects heart valves.
- Complete heart block is an uncommon complication of infective endocarditis.
Observation:
- A patient presented with chest pain, ST elevation, and complete heart block.
- The patient experienced sudden, unexpected expiration shortly after presentation.
Findings:
- Postmortem examination revealed an atrial septal abscess, purulent pericardial collection, and fibrinous pericarditis.
- Abscess extension into the atrial septum was the likely cause of complete heart block.
Implications:
- Severe infective endocarditis with heart block indicates extensive infection.
- Management necessitates urgent ventricular pacing, potential valve replacement, and pericardial drainage.
Abstract:
Intracardiac abscess resulting in complete heart block is an infrequent complication of infective endocarditis. Most presentations of endocarditis are limited to valvular and perivalvular structures, with varying degrees of heart block occurring in the minority of cases. We report a case of endocarditis manifesting as chest pain associated with ST segment elevation and complete heart block. The patient expired unexpectedly within a few hours of presentation. Postmortem examination revealed an atrial septal abscess, purulent pericardial collection, and fibrinous pericarditis. Spread of the abscess into the atrial septum was postulated to be the cause of the complete heart block. In endocarditis, the ominous development of heart block and a poor response to antibiotic therapy imply significant extension of the infection. Management therefore requires prompt ventricular pacing with consideration for valve replacement and possible pericardial drainage.
Related Concept Videos
Endocarditis I: Introduction
Endocarditis II: Clinical Features of Infective Endocarditis
Endocarditis IV: Nursing Management
Endocarditis III: Medical Management
Rheumatic Heart Disease I: Introduction
Pericarditis I: Introduction

