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.

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