Infective endocarditis of intracardiac devices: problems of diagnosis and treatment

The use of implantable intracardiac devices (ICD) has increased significantly over the past few decades. The incidence of ICD-associated infections has increased disproportionally to the increase in the number of device implantations. As with other forms of infective endocarditis, microbiological testing of blood for sterility and echocardiographic (ECHO) examination are the basis for diagnosing ICD infection. Positive blood culture and clinical signs remain key to diagnosing infective endocarditis, which is currently characterized by an erased, low-symptom clinical picture, and sometimes a completely asymptomatic course. In this regard, the search for “silent” forms of vascular and immunological phenomena using modern diagnostic methods (18F-fluorodeoxyglucose positron emission tomography/computed tomography) is of particular importance. However, the use of these methods in routine practice is limited. That is why a carefully collected anamnesis with a special emphasis on the search for cardiological problems, identification of predisposing social factors and pathology of internal organs is of great importance. A clinical case is presented, the peculiarity of which is the recurrent course of the disease with the formation of complications characteristic of infective endocarditis - embolic syndrome, development of acute kidney injury, decompensation of chronic heart failure. Considering the negative results of the analysis of microbiological blood tests at all stages of the recurrent course of the disease, the diagnosis was determined on the basis of echocardiography/transesophageal echocardiography and the clinical picture of the disease.