Atrioventricular block: An unusual presentation of infective endocarditis

Atrioventricular conduction disturbances are uncommon as the first presentation of infective endocarditis (IE) and are often related to the extension of the valve infection around the annulus and a perivalvular abscess. The electrocardiogram can be useful in the diagnosis of IE. New onset atrioventricular conduction disturbances in a patient with a prosthetic valve, make the diagnosis of IE likely. We present a patient, with an aortic prosthesis, without any sign of sepsis, in whom a type I seconddegree atrioventricular block was the first clinical finding of IE. The patient was admitted for pacemaker implantation because of symptomatic atrioventricular block. Two days after admission, fever was present and Streptococcus viridans grew in blood cultures. An echocardiogram showed a vegetation on the prosthetic valve. In prosthetic valve carriers, echocardiography could be encouraged to preclude IE before pacemaker implant, even when signs or symptoms of sepsis are absent, avoiding electrode infection.