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
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American Journal of Medical Case Reports. 2021, 9(11), 522-526
DOI: 10.12691/ajmcr-9-11-1
Open AccessCase Report

Clickbait: A Rare Case of Monomorphic Ventricular Tachycardia and Clicking Sensation without Infectious Presentation Revealed as Infective Endocarditis with Aortic Root Abscess

Mahmoud S. Ahmed1, Mouhamed Nashawi2, , Toka Amin3, Mahmoud Ahmad4 and Mujahed Abualfoul5

1Department of Medicine-Cardiology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, Mail Code 7872, San Antonio, TX  78229

2Department of Internal Medicine, Baylor Scott & White All Saints Medical Center, 1400 8th Ave, Fort Worth, Texas, USA 76104

3Department of Internal Medicine, Cairo University, Faculty of Medicine, Cairo, Egypt

4Department of Biology, The University of Texas at Arlington, 701 S. Nedderman Dr., Arlington, TX, 76019

5Department of Internal Medicine, Methodist Dallas Medical Center, 1441 N. Beckley Ave., Dallas, TX, 75203

Pub. Date: July 07, 2021

Cite this paper:
Mahmoud S. Ahmed, Mouhamed Nashawi, Toka Amin, Mahmoud Ahmad and Mujahed Abualfoul. Clickbait: A Rare Case of Monomorphic Ventricular Tachycardia and Clicking Sensation without Infectious Presentation Revealed as Infective Endocarditis with Aortic Root Abscess. American Journal of Medical Case Reports. 2021; 9(11):522-526. doi: 10.12691/ajmcr-9-11-1

Abstract

Presenting symptoms of infective endocarditis (IE) typically includes infectious signs such as diaphoresis, fever, and malaise. Pathogenic microorganisms implicated in IE may form vegetations, collection of debris that may subsequently embolize. Notable complications and concomitant sequelae of systemic embolization from resulting from valvular vegetations include stroke, acute renal failure, and cutaneous manifestations. Valvular dysfunction warranting surgical repair does not preclude redo-repairs from subsequent emboli, highlighting the extensive propensity of IE to cause acute decompensation across multiple domains. A presenting feature of arrhythmia stemming from valvular dysfunction have been appreciated in the literature. However, literary accounts of ventricular tachycardia (VT) as the resultant arrhythmia are scant. Moreover, these accounts usually include concomitant infectious presentation. We report the case of a 36-year-old male with a past medical history of Bartonella spp. endocarditis and aortic valve repair who appeared to the emergency department with acute onset monomorphic VT. Complicating his presentation was a reported sensation of clicking in his surgically repaired valve while lacking infectious symptoms. Arrhythmia was treated with further workup delineating S. epidermidis vegetations and aortic root abscess successfully treated with antibiotics and ICD placement.

Keywords:
ventricular tachycardia endocarditis bartonella valvular Vtach

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References:

[1]  Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology 2018; 72(14): e91-e220.
 
[2]  Antzelevitch C, Burashnikov A. Overview of basic mechanisms of cardiac arrhythmia. Cardiac electrophysiology clinics 2011; 3(1): 23-45.
 
[3]  Fernández-Armenta J, Penela D, Acosta J, et al. Substrate modification or ventricular tachycardia induction, mapping, and ablation as the first step? A randomized study. Heart Rhythm 2016; 13(8): 1589-1595.
 
[4]  Graner M, Lommi J, Kupari M, Räisänen-Sokolowski A, Toivonen L. Multiple forms of sustained monomorphic ventricular tachycardia as common presentation in giant-cell myocarditis. Heart 2007; 93(1): 119-121.
 
[5]  Nery PB, Mc Ardle BA, Redpath CJ, et al. Prevalence of cardiac sarcoidosis in patients presenting with monomorphic ventricular tachycardia. Pacing and Clinical Electrophysiology 2014; 37(3): 364-374.
 
[6]  Ouyang F, Fotuhi P, Ho SY, et al. Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation. Journal of the American College of Cardiology 2002; 39(3): 500-508.
 
[7]  Spies C, Madison JR, Schatz IJ. Infective endocarditis in patients with end-stage renal disease: clinical presentation and outcome. Archives of Internal Medicine 2004; 164(1): 71-75.
 
[8]  Chaudry MS, Carlson N, Gislason GH, et al. Risk of infective endocarditis in patients with end stage renal disease. Clinical Journal of the American Society of Nephrology 2017; 12(11): 1814-1822.
 
[9]  García-Cabrera E, Fernández-Hidalgo N, Almirante B, et al. Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study. Circulation 2013; 127(23): 2272-2284.
 
[10]  Rohde H, Burandt EC, Siemssen N, et al. Polysaccharide intercellular adhesin or protein factors in biofilm accumulation of Staphylococcus epidermidis and Staphylococcus aureus isolated from prosthetic hip and knee joint infections. Biomaterials 2007; 28(9): 1711-1720.
 
[11]  Haunreiter VD, Boumasmoud M, Häffner N, et al. In-host evolution of Staphylococcus epidermidis in a pacemaker-associated endocarditis resulting in increased antibiotic tolerance. Nature communications 2019; 10(1): 1-14.
 
[12]  Hamandi M, Khan Z, Bolin M, et al. PUZZLED BY THE POUCH: AORTIC ROOT ABSCESS PRESENTING AS VENTRICULAR TACHYCARDIA. Journal of the American College of Cardiology 2020; 75(11 Supplement 1): 2958.
 
[13]  Islam AKMM, Sayami LA, Zaman S. Chiari network: a case report and brief overview. Journal of the Saudi Heart Association 2013; 25(3): 225-229.
 
[14]  Mishra AK, Sahu KK, Lal A, Menon V. Aortic valve abscess: Staphylococcus epidermidis and infective endocarditis. QJM: An International Journal of Medicine 2020; 113(3): 211-212.
 
[15]  Killu AM, Stevenson WG. Ventricular tachycardia in the absence of structural heart disease. Heart 2019; 105(8): 645-656.