The use of point‐of‐care ultrasound to diagnose infective endocarditis causing an NSTEMI in a patient with chest pain

Cohen, Allison; Greco, Jeff; Levitus, Matthew; Nelson, Mathew

doi:10.1002/emp2.12004

Cited by 5 publications

(7 citation statements)

References 13 publications

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“…There are conflicting data in the literature according to which a valve affected by IE is most commonly responsible for the development of septic embolic-induced AMI: there are studies that claim that the aortic valve is most commonly responsible for septic embolization in coronary arteries, with the subsequent development of AMI [19,21,27], similar to our findings. There are also previous studies suggesting that vegetations on the mitral valve have the highest embolic risk [25,35,48,54].…”

Section: The Valve With the Highest Embolic Risk Leading To Acute Myo...supporting

confidence: 80%

Multidisciplinary Perspectives of Challenges in Infective Endocarditis Complicated by Septic Embolic-Induced Acute Myocardial Infarction

Stamate,

Ciobotaru,

Arbune

et al. 2024

Antibiotics

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Background: Infective endocarditis (IE) management is challenging, usually requiring multidisciplinary collaboration from cardiologists, infectious disease specialists, interventional cardiologists, and cardiovascular surgeons, as more than half of the cases will require surgical procedures. Therefore, it is essential for all healthcare providers involved in managing IE to understand the disease’s characteristics, potential complications, and treatment options. While systemic embolization is one of the most frequent complications of IE, the coronary localization of emboli causing acute myocardial infarction (AMI) is less common, with an incidence ranging from 1% to 10% of cases, but it has a much higher rate of morbidity and mortality. There are no guidelines for this type of AMI management in IE. Methods: This narrative review summarizes the current knowledge regarding septic coronary embolization in patients with IE. Additionally, this paper highlights the diagnosis and management challenges in such cases, particularly due to the lack of protocols or consensus in the field. Results: Data extracted from case reports indicate that septic coronary embolization often occurs within the first two weeks of the disease. The aortic valve is most commonly involved with vegetation, and the occluded vessel is frequently the left anterior descending artery. Broad-spectrum antibiotic therapy followed by targeted antibiotic therapy for infection control is essential, and surgical treatment offers promising results through surgical embolectomy, concomitant with valve replacement or aspiration thrombectomy, with or without subsequent stent insertion. Thrombolytics are to be avoided due to the increased risk of bleeding. Conclusions: All these aspects should constitute future lines of research, allowing the integration of all current knowledge from multidisciplinary team studies on larger patient cohorts and, subsequently, creating a consensus for assessing the risk and guiding the management of this potentially fatal complication.

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Section: The Valve With the Highest Embolic Risk Leading To Acute Myo...supporting

confidence: 80%

Multidisciplinary Perspectives of Challenges in Infective Endocarditis Complicated by Septic Embolic-Induced Acute Myocardial Infarction

Stamate,

Ciobotaru,

Arbune

et al. 2024

Antibiotics

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“…Early diagnosis and immediate reperfusion are pivotal for mitigating the impact of myocardial infarction and infarct size, thereby reducing potential complications and heart failure after STEMI [160]. Relatively, NSTEMI is often the result of unstable plaque formations, which lead to the partial occlusion of the coronary artery, albeit with minimal blood flow [161,162]. Although Electrocardiogram (ECG) indications of ST-segment elevation serve as sensitive and specific signs of Total coronary Occlusion (TO) in STEMI patients, TO is detected in merely 25.5-34% of NSTEMI patients [153].…”

Section: Exosomes In Myocardial Infarctionmentioning

confidence: 99%

Unraveling the Intricate Roles of Exosomes in Cardiovascular Diseases: A Comprehensive Review of Physiological Significance and Pathological Implications

Zhang,

Yang,

et al. 2023

IJMS

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Exosomes, as potent intercellular communication tools, have garnered significant attention due to their unique cargo-carrying capabilities, which enable them to influence diverse physiological and pathological functions. Extensive research has illuminated the biogenesis, secretion, and functions of exosomes. These vesicles are secreted by cells in different states, exerting either protective or harmful biological functions. Emerging evidence highlights their role in cardiovascular disease (CVD) by mediating comprehensive interactions among diverse cell types. This review delves into the significant impacts of exosomes on CVD under stress and disease conditions, including coronary artery disease (CAD), myocardial infarction, heart failure, and other cardiomyopathies. Focusing on the cellular signaling and mechanisms, we explore how exosomes mediate multifaceted interactions, particularly contributing to endothelial dysfunction, oxidative stress, and apoptosis in CVD pathogenesis. Additionally, exosomes show great promise as biomarkers, reflecting differential expressions of NcRNAs (miRNAs, lncRNAs, and circRNAs), and as therapeutic carriers for targeted CVD treatment. However, the specific regulatory mechanisms governing exosomes in CVD remain incomplete, necessitating further exploration of their characteristics and roles in various CVD-related contexts. This comprehensive review aims to provide novel insights into the biological implications of exosomes in CVD and offer innovative perspectives on the diagnosis and treatment of CVD.

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“…Based on the Duke Criteria, these patients would not have met the diagnosis of endocarditis upon initial presentation and resuscitation in the emergency department. Although the role of POCUS in diagnosing endocarditis has not yet been well established, there has been an increasing amount of case reports where POCUS evidence of valvular lesions has changed the course of management [8][9][10][11][12]. Though it is important to note that the absence of valvular lesions does not rule out the possibility of infective endocarditis.…”

Section: Discussionmentioning

confidence: 99%

Endocarditis in the Emergency Department: A POCUS Case Series

DeAngelis¹

2022

Curr Res Emerg Med

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Introduction Infectious endocarditis remains a difficult to diagnose entity in the emergency department. This is partially due to vague and non-specific presenting symptoms but also because the Major Duke criteria [1,2] are difficult to achieve in the timeframe of the standard emergency department visit. This can lead to diagnostic uncertainty and delay in treatment. Point of Care Ultrasound (POCUS) has grown significantly in the emergency setting and is now readily available in most departments [3]. Utilizing POCUS in this difficult subset of patients can successfully identify endocarditis earlier and lead to improved treatment times. Cases Each of the three cases in this report demonstrate an episode of care in which the patient presented with non-specific symptoms. In two, endocarditis was suspected, while in the third case there was significant distraction to make the diagnosis very difficult. In each case, POCUS was applied successfully confirming the diagnosis of endocarditis when added to the minor Duke criteria already present. This led to a confirmation of diagnosis up to 12 hours before formal confirmation during the patients’ admissions. Conclusion While this specific indication for POCUS is currently outside the core utilization in the ED, and significant limitations remain: i.e. unknown sensitivity, this series demonstrates that POCUS provides value in the work up of suspected endocarditis by confirming the diagnosis earlier. This series suggests that further research into the sensitivity of POCUS for endocarditis in the ED may be warranted.

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The use of point‐of‐care ultrasound to diagnose infective endocarditis causing an NSTEMI in a patient with chest pain

Cited by 5 publications

References 13 publications

Multidisciplinary Perspectives of Challenges in Infective Endocarditis Complicated by Septic Embolic-Induced Acute Myocardial Infarction

Multidisciplinary Perspectives of Challenges in Infective Endocarditis Complicated by Septic Embolic-Induced Acute Myocardial Infarction

Unraveling the Intricate Roles of Exosomes in Cardiovascular Diseases: A Comprehensive Review of Physiological Significance and Pathological Implications

Endocarditis in the Emergency Department: A POCUS Case Series

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