Dataset Information

Uncommon Cardiac Manifestations of Left-sided Pseudomonas Endocarditis in an Intravenous Drug Abuser with an Undiagnosed Atrial Septal Defect.

ABSTRACT: A 56-year-old male, who is an active intravenous drug abuser (IVDA) (heroin) with a history of diabetes, hypertension, chronic kidney disease, and hepatitis C-related liver cirrhosis, presented with generalized anasarca, bilateral pneumonic infiltrations, and heart failure. His blood cultures were positive for Pseudomonas aeruginosa and were treated with antibiotics. Echocardiogram showed multiple uncommon manifestations of left-sided endocarditis. Surprisingly, he did not have right-sided involvement. Furthermore, echocardiogram revealed undiagnosed large atrial septal defect suggesting a paradoxical seeding of infective vegetation. This case illustrates the uncommon manifestations of Pseudomonas endocarditis in an IVDA and indicates that it is very important to check comprehensively for an atrial septal defect or patent foramen ovale or any shunt in such high-risk patients who may be at risk for left-sided endocarditis which is catastrophic when compared to right-sided endocarditis. If detected early in IVDA patients, these shunts need to be closed to prevent paradoxical embolism of vegetation.

SUBMITTER: Panduranga P

PROVIDER: S-EPMC5353468 | biostudies-literature | 2017 Jan-Mar

REPOSITORIES: biostudies-literature

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Uncommon Cardiac Manifestations of Left-sided <i>Pseudomonas</i> Endocarditis in an Intravenous Drug Abuser with an Undiagnosed Atrial Septal Defect.

Panduranga Prashanth P Al-Abri Seif S Rajarao Mamatha Punjee MP

Journal of cardiovascular echography 20170101 1

A 56-year-old male, who is an active intravenous drug abuser (IVDA) (heroin) with a history of diabetes, hypertension, chronic kidney disease, and hepatitis C-related liver cirrhosis, presented with generalized anasarca, bilateral pneumonic infiltrations, and heart failure. His blood cultures were positive for <i>Pseudomonas aeruginosa</i> and were treated with antibiotics. Echocardiogram showed multiple uncommon manifestations of left-sided endocarditis. Surprisingly, he did not have right-side ...[more]

PMID: 28465984

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Project description:Background Despite correction of the atrial septal defect (ASD), patients experience atrial fibrillation frequently and have increased morbidity and mortality. We examined physical capacity, cardiac performance, and invasive hemodynamics in patients with corrected ASD. Methods and Results Thirty-eight corrected patients with isolated secundum ASD and 19 age-matched healthy controls underwent right heart catheterization at rest and during exercise with simultaneous expired gas assessment and echocardiography. Maximum oxygen uptake was comparable between groups (ASD 32.7±7.7 mL O2/kg per minute, controls 35.2±7.5 mL O2/kg per minute, P=0.3), as was cardiac index at both rest and peak exercise. In contrast, pulmonary artery wedge v wave pressures were increased at rest and peak exercise (rest: ASD 14±4 mm Hg, controls 10±5 mm Hg, P=0.01; peak: ASD 25±9 mm Hg, controls 14±9 mm Hg, P=0.0001). The right atrial v wave pressures were increased at rest but not at peak exercise. The transmural filling pressure gradient (TMFP) was higher at peak exercise among patients with ASD (10±6 mm Hg, controls 7±3 mm Hg, P=0.03). One third of patients with ASD demonstrated an abnormal hemodynamic exercise response defined as mean pulmonary artery wedge pressure ≥25 mm Hg and/or mean pulmonary artery pressure ≥35 mm Hg at peak exercise. These patients had significantly elevated peak right and left atrial a wave pressures, right atrial v wave pressures, pulmonary artery wedge v wave pressures, and transmural filling pressure compared with both controls and patients with ASD with a normal exercise response. Conclusions Patients with corrected ASD present with elevated right and in particular left atrial pressures at rest and during exercise despite preserved peak exercise capacity. Abnormal atrial compliance and systolic atrial function could predispose to the increased long-term risk of atrial fibrillation. Registration Information clinicaltrials.gov. Identifier: NCT03565471.

Dataset Information

Uncommon Cardiac Manifestations of Left-sided Pseudomonas Endocarditis in an Intravenous Drug Abuser with an Undiagnosed Atrial Septal Defect.

Publications

Uncommon Cardiac Manifestations of Left-sided <i>Pseudomonas</i> Endocarditis in an Intravenous Drug Abuser with an Undiagnosed Atrial Septal Defect.

Similar Datasets

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