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. McFarlane^1,

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

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

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