Elsevier

The American Journal of Cardiology

Volume 137, 15 December 2020, Pages 127-129
The American Journal of Cardiology

Virtually All Complications of Active Infective Endocarditis Occurring in a Single Patient

https://doi.org/10.1016/j.amjcard.2020.09.025Get rights and content

Described herein is a 49-year-old black man with advanced polycystic renal disease, on hemodialysis for 6 years, who during his last 12 days of life had his vegetations on the aortic valve extend to the mitral and tricuspid valves, through the aortic wall to produce diffuse pericarditis, to the atrioventricular node to produce complete heart block, and embolize to cerebral arteries producing multiple brain infarcts, to a branch on the left circumflex coronary artery producing acute myocardial infarction, and to mesenteric arteries producing bowel infarction.

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Case Description

A 49-year-old black man with known advanced polycystic renal disease on hemodialysis (for 6 years), diabetes mellitus, systemic hypertension, and obstructive sleep apnea (without obesity—body weight 176 lbs.) had been in his usual health until he developed epigastric, back, and vague chest pain 3 days before hospitalization. Examination in the emergency room disclosed a grade 2/6 systolic murmur along the lower left sternal border. The patient indicated that his chest pain worsened when lying

Discussion

Of the various cardiac valves affected by infective endocarditis, the aortic by far is the most common and it also is associated with the most complications.1 Chronic renal disease, as in the present patient is a major risk factor for infective endocarditis.2 These complications include destruction of the aortic valve cusps causing aortic regurgitation, extension of the cuspal infection to adjacent tissues (ring abscess), including the anterior mitral leaflet and its chordae tendinea producing

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