1. Significant PR Prolongation and New Onset Left Bundle Branch Block in Aortic Root Abscess: A Marker of Disease Progression and Poor Prognosis
- Author
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Apoorva Jayarangaiah, Samy I. McFarlane, Ashkan Tadayoni, Moro O. Salifu, Volodymyr Vulkanov, Vivek Yadav, Adam S Budzikowski, and Pramod Theetha Kariyanna
- Subjects
medicine.medical_specialty ,030204 cardiovascular system & hematology ,medicine.disease_cause ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,left bundle branch block ,cardiovascular diseases ,030212 general & internal medicine ,General Environmental Science ,infective endocarditis ,business.industry ,Left bundle branch block ,Mortality rate ,Prolongation ,medicine.disease ,Methicillin-resistant Staphylococcus aureus ,Pathophysiology ,PR prolongation ,aortic root abscess ,Staphylococcus aureus ,Infective endocarditis ,Bacteremia ,Cardiology ,General Earth and Planetary Sciences ,prognosis ,business - Abstract
Infective endocarditis (IE) is a serious medical condition with a high morbidity and mortality rate. Staphylococcus aureus is the most common etiologic organism in IE. While echocardiography plays an important role in diagnosis and management of IE, the electrocardiogram (ECG) is helpful in determination of disease progression as well as in prognostication. We present a case of a 72-year-old man who was diagnosed with IE following methicillin resistant Staphylococcus aureus (MRSA) bacteremia. The course of hospitalization was complicated with multiple septic-embolic strokes and aortic root abscess. Serial ECG revealed PR prolongation and new onset left bundle branch block (LBBB) before the patient became terminal. Our case highlights the utility of serial ECGs monitoring in the patients with IE that may reveal subtle ECG findings, such as PR prolongation and LBBB. These findings which might serve as a clue of the presence of peri-annular extension of IE, help in prognostication and aid in the therapeutic decision-making such as early surgical intervention in these high-risk patients with poor prognosis. In this report, we also present the pathophysiologic mechanisms underlining the ECG changes in patients with aortic valve endocarditis.
- Published
- 2020