Cardiac rupture caused by Staphylococcus aureus septicaemia and pericarditis: an incidental finding

Abstract

A 35 year old woman with a long history of intravenous drug abuse presented to a local hospital with severe anaemia, fever, raised markers of inflammation, and positive blood cultures for Staphylococcus aureus. She responded to treatment with antibiotics with improvement in her symptoms and markers of inflammation. Four weeks later a "routine" echocardiogram showed a rupture of her left ventricular apex and a large pseudoaneurysm. There had been no deterioration in her symptoms or haemodynamic status to herald this new development. It was successfully repaired surgically and the patient made a good recovery. (Heart 2001;85:e4) Keywords: ventricular rupture; pseudoaneurysm; staphylococcal septicaemia Cardiac rupture and pseudoaneurysm of the left ventricular free wall is a well recognised complication of myocardial infarction, cardiac trauma or cardiac surgery.1 2 There are a few reported associations with endocarditis, septicaemia or tumour infiltration.3-6 These reported cases are all associated with a sudden or progressive haemodynamic deterioration. We report a case of cardiac rupture and pseudoaneurysm of the left ventricular free wall found on "routine" echocardiography in a patient with Staphylococcus aureus septicaemia. Case reportA 35 year old female intravenous drug abuser was referred to a local hospital with a three week history of malaise, lethargy, and weight loss. She had lost 10 kg in three weeks and complained of left sided pleuritic chest pains.She had a long history of intravenous drug misuse and had been on a methadone withdrawal programme for two months, although she admitted to the concomitant use of heroine. In 1992 and 1997 she was admitted to the same hospital with a left proximal deep vein thrombosis and right groin abscess respectively caused by injecting heroin into her femoral vein. A systolic murmur had been heard and an echocardiogram booked, but she had defaulted.On examination she looked ill and had a low grade pyrexia. She had a tachycardia of 100 beats/min but was normotensive. There were no cutaneous stigmata of endocarditis and the only positive finding was a systolic murmur suggestive of mitral regurgitation.Investigations revealed a microcytic anaemia with a haemoglobin of 3.5 mmol/l (5.7 g/d1) and a white cell count of 10.7 × 10 9 /l. Inflammatory markers were raised (C reactive protein 130 mg/l and erythrocyte sedimentation rate 54 mm/hour), and two sets of blood cultures grew S aureus. Her chest x ray was normal. The ECG showed non-specific T wave inversion aVecting the inferiolateral leads. Her echocardiogram revealed normal left ventricular systolic function and a left ventricular band near the apex. There was mild mitral and tricuspid regurgitation but no vegetations were seen. The aortic valve was normal. A small pericardial eVusion was noted. A diagnosis of bacterial endocarditis was made and she was treated with appropriate antibiotics (flucloxacillin and gentamicin) and given a transfusion of 4 units of blood. Her temperature settled and markers of infla...

A Case of Primary Bacterial Pericarditis with Recurrent Cardiac Tamponade

“…There were only 6 cases of cardiac rupture due to primary bacterial or purulent pericarditis with cardiac rupture, excluding endocarditis, aortic dissection, infectious aortic aneurysm, ischemic heart disease and trauma 5 9 , ( Table 1) . In our patient, we believe that the infected tissue was severely damaged because the Staphylococcus aureus was very tissuedestructive 6 . Hence, the unexpected rupture occurred again in the subacute phase.…”

Cardiac Phlegmon: Infectious Endocarditis Causing Ventricular Wall Rupture

“…To our knowledge, this is the first report on the development of a myocardial phlegmon with acute free wall rupture. Previously, phlegmonlike changes of the myocardial tissue have been reported by Osula et al 7 However, the authors described myocardial involvement in close proximity to skeptically destructed aortic and mitral valves in severe endocarditis. In our case, the cardiac phlegmon was localized in a free lateral wall of the left ventricle and was probably triggered by a septic coronary embolization.…”

Metastatic Complications of Pericarditis and Cardiac Tamponade as a Result of <i>Staphylococcus aureus</i> Bacteremia Developing during Antimicrobial Therapy

“…Pericarditis was detected in two (5.6%) of 36 hospitalized children with SAB in one pediatric study (9), whereas the incidence of pericarditis in adult patients with SAB is not known due to its rarity. Adult cases of SAB complicated by pericarditis usually appear as case reports and occur in both immunocompromised and immunocompetent individuals (10)(11)(12).…”

“…Similar conditions were also noticed in a 35-year-old female intravenous drug user with SAB who responded to initial antimicrobial treatment, showing improvements in her symptoms and markers of inflammation. However, rupture of her left ventricular apex and the development of a large pseudoaneurysm was demonstrated four weeks later on "routine" echocardiogram (12). Therefore, the importance of providing echocardiographic monitoring during antimicrobial treatment should be emphasized, especially for patients with new pericardial effusions.…”