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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Based on the clinical, instrumental and biochemical findings, out of 104 patients with septic endocarditis 11 (10.6%) were diagnosed to have myocardial infarction. It was provoked by coronary artery embolism, the covering of the coronary artery ostium by vegetation from the aortal cusp, a decrease of perfusion pressure in atherosclerosis stenosed coronary arteries because of marked insufficiency of the aortal cusp. In more than half the cases, the clinical picture of myocardial infarction was atypical, painless. Echocardiographic demonstration of the vegetations near the coronary artery ostium permits forecasting the possibility of its covering with vegetation, the threat of the occurrence of acute coronary insufficiency, which may appear an additional indication for heart valve replacement.
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PMID:[The mechanisms of the development and diagnosis of myocardial infarct in septic endocarditis]. 144 Mar 11

The surgical treatment of acute heart failure is limited to cases of pressure or volume overload. Acute valvular regurgitation due to active endocarditis or to prosthetic dysfunction is a classic example of failure which can be cured by restoring valvular competence. Acute pressure load is mostly caused by prosthetic dysfunction or pulmonary embolism; therapy is aimed at removal of the causative agent. Coronary heart disease can cause heart failure by volume overload: acute mitral incompetence or ventricular septal defect lend themselves to surgical correction. In the surgical treatment of acute heart failure maximal attention is devoted to optimal timing of surgery, anesthetic management and postoperative care. Careful attention to the function of the right and left ventricle and combination of catecholamines, afterload reducing agents and volume loading together with respirator support have considerably improved the surgical results. Acute pump failure due to coronary insufficiency and infarction is less amenable to surgical treatment, with rare exceptions of emergencies during coronary angiography and percutaneous dilatation. The intra-aortic balloon pump is the only method of mechanical circulatory assistance which has reached widespread clinical acceptance. The best results are achieved in conjunction with surgery: either as cardiac support in inherently reversible postoperative heart failure or as the means of circulatory stabilization prior to surgery. Ventricular assist devices are still in the experimental stage: their use has been sharply curtailed by the virtual disappearance of the postoperative low output syndrome. In selected cases of end-stage cardiomyopathy cardiac transplantation is nowadays performed with acceptable survival (70% at one year after surgery). Both orthotopic and heterotopic transplantation (transplanted heart in parallel with the natural one) give comparable results, but the procedure is still very restricted due to the lack of donors, multiple contraindications and lack of suitable heart preservation techniques.
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PMID:Surgical and mechanical support of the failing heart. 622 Aug 97

The authors report on a 47-years old woman with bacterial endocarditis involving both the mitral and aortic valves. At first echocardiographic examination, the mitral vegetation was small, while the aortic one was large highly mobile. Despite adequate antibiotic therapy, the aortic vegetation had become bigger and the valve regurgitation, initially mild to moderate, resulted severe and was associated with left heart failure. While awaiting surgery, the patient sustained an acute non Q wave myocardial infarction with ST segment elevation in inferior and anterolateral leads, complicated by ventricular arrhythmias. Thirty-six hours later, the patient received mitral and aortic valve replacement: at surgical view, the aortic vegetations was found to be very close to the right coronary orifice. After a period of further antibiotic therapy, the woman discharged and at a six months follow-up, she was fairly well. The authors review the mechanisms of acute coronary insufficiency in infective endocarditis and suggest an embolic pathogenesis in the case reported. Taking into account the possible life threatening embolic complications, it seems reasonable not to delay surgery when antibiotic therapy fails to reduce the size and mobility of valve vegetations.
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PMID:[Acute myocardial infarction in bacterial endocarditis]. 866 78