American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2020, 8(9), 315-320
DOI: 10.12691/ajmcr-8-9-15
Open AccessCase Report

Significant PR Prolongation and New Onset Left Bundle Branch Block in Aortic Root Abscess: A Marker of Disease Progression and Poor Prognosis

Pramod Theetha Kariyanna1, Ashkan Tadayoni1, Apoorva Jayarangaiah2, Vivek Yadav3, Volodymyr Vulkanov3, Adam Budzikowski1, Moro O. Salifu1 and Samy I. McFarlane1,

1Division of Cardiovascular Disease and Department of Internal Medicine, State University of New York- Downstate Health Science University, Brooklyn, NY, USA- 11203

2Department of Internal Medicine, NYC Health + Hospitals/Jacobi Medical Center, Bronx, N.Y., U.S.A-10461

3Department of Neurology, Brookdale University Hospital and Medical center, Brooklyn, NY, U.S.A- 11203

Pub. Date: June 11, 2020

Cite this paper:
Pramod Theetha Kariyanna, Ashkan Tadayoni, Apoorva Jayarangaiah, Vivek Yadav, Volodymyr Vulkanov, Adam Budzikowski, Moro O. Salifu and Samy I. McFarlane. Significant PR Prolongation and New Onset Left Bundle Branch Block in Aortic Root Abscess: A Marker of Disease Progression and Poor Prognosis. American Journal of Medical Case Reports. 2020; 8(9):315-320. doi: 10.12691/ajmcr-8-9-15

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.

Keywords:
infective endocarditis PR prolongation left bundle branch block aortic root abscess prognosis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Baddour Larry M, Wilson Walter R, Bayer Arnold S, Fowler Vance G, Tleyjeh Imad M, Rybak Michael J, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications. Circulation. 2015; 132(15): 1435-86.
 
[2]  Lalani T, Cabell Christopher H, Benjamin Daniel K, Lasca O, Naber C, Fowler Vance G, et al. Analysis of the Impact of Early Surgery on In-Hospital Mortality of Native Valve Endocarditis. Circulation. 2010; 121(8): 1005-13.
 
[3]  Kiefer T, Park L, Tribouilloy C, Cortes C, Casillo R, Chu V, et al. Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure. Jama. 2011; 306(20): 2239-47.
 
[4]  Graupner C, Vilacosta I, SanRomán J, Ronderos R, Sarriá C, Fernández C, et al. Periannular extension of infective endocarditis. Journal of the American College of Cardiology. 2002; 39(7): 1204-11.
 
[5]  Baddour LM, Wilson WR, Bayer AS, Fowler Jr VG, Tleyjeh IM, Rybak MJ, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015; 132(15): 1435-86.
 
[6]  Anderson RH. The surgical anatomy of the aortic root. Multimedia manual of cardiothoracic surgery: MMCTS. 2007; 2007(102): mmcts. 2006. 002527.
 
[7]  Gill EA, Jr. Definitions and pathophysiology of the patent foramen ovale: broad overview. Cardiology Clinics. 2005; 23(1): 1-6.
 
[8]  Weisse AB, Khan MY. The relationship between new cardiac conduction defects and extension of valve infection in native valve endocarditis. Clinical cardiology. 1990; 13(5): 337-45.
 
[9]  Ullah S, Elbita O, Abdelghany M, Tahir H, Tuli P, Alkilani WZ, et al. Klebsiella oxytoca Endocarditis With Complete Heart Block. Journal of Investigative Medicine High Impact Case Reports. 2016; 4(3): 2324709616663232.
 
[10]  Jain R, Kader M, Sajeev CG, Krishnan MN. Aortic root abscess presenting as alternating bundle branch block: Infective endocarditis of bicuspid aortic valve. Indian Heart J. 2015; 67(3): 266-7.
 
[11]  Fenichel NM, Jimenez FA, Polachek AA. 2:1 left bundle branch block in acute bacterial endocarditis with septal abscess. Journal of electrocardiology. 1977; 10(3): 287-90.
 
[12]  Ameen M. Intermittent Left Bundle Branch Block–A Challenging Case of Rare Electrocardiogram Phenomenon. Journal-Intermittent Left Bundle Branch Block–A Challenging Case of Rare Electrocardiogram Phenomenon. 2018.
 
[13]  Daniell JE, Nelson BS, Ferry D. ED identification of cardiac septal abscess using conduction block on ECG. The American journal of emergency medicine. 2000; 18(6): 730-4.
 
[14]  Lammers J, van Dantzig JM. Images in cardiology. PR prolongation in aortic root abscess. Heart (British Cardiac Society). 2005; 91(11): 1474.
 
[15]  Blumberg EA, Karalis DA, Chandrasekaran K, Wahl JM, Vilaro J, Covalesky VA, et al. Endocarditis-associated paravalvular abscesses: do clinical parameters predict the presence of abscess? Chest. 1995; 107(4): 898-903.