Key result
Pacemaker endocarditis presents with PE and severe TR despite absent fever.
Why the study?
The increasing number of patients with implantable cardiac devices is accompanied by rising complications such as infectious endocarditis, pulmonary embolism, and tricuspid valve damage, with diagnostic and management challenges especially in centers lacking surgical capabilities.
Case Report (n=1)
This case underscores the critical need for antibiotic prophylaxis and high clinical suspicion for infectious endocarditis in patients with cardiac implantable devices, even when typical symptoms like fever are absent.
Answers are grounded in this paper and cite their sources.
May heighten suspicion for endocarditis in afebrile pacemaker recipients; leaves open optimal prophylaxis and intervention timing.
INTRODUCTION: The number of patients with implantable cardiac devices (CDs) is steadily growing in the world and, in parallel with this, the number of complications associated with these devices, including infectious endocarditis (IE), arterial embolisms and mechanical damage to the heart valves. A case of patient P., 51 year old, diagnosed with IE of CD, pulmonary embolism and progression of tricuspid regurgitation to the 3rd degree with a previously implanted Sensia SR VVI pacemaker is presented. The peculiarities of this clinical case are highly probable existence of the source of infection (the patient suffered acute paraproctitis with unauthorized opening of the abscess without antibiotic therapy), severe comorbid pathology, the absence of fever throughout the entire follow-up period, the absence of visualized involvement of the valve apparatus with the presence of blood clots around the pacemaker electrodes, and the inability to remove infected pacemaker electrodes in the acute period for technical reasons. The difficulties of diagnosis and management of such patients in the conditions of the Regional Vascular Center without the technical possibilities for surgical treatment are discussed. CONCLUSION: This clinical case actualizes: the importance of informing patients with CDs about the need for both antibiotic prophylaxis in high-risk invasive interventions and antibiotic therapy in infectious diseases of any location and complexity; the importance of continuous monitoring of patients with CDs by a cardiologist and/or therapist with the maximum possible correction of all comorbidities; the reasonability of high attention of doctors of various specialties to the presence of IE in the patient even in the absence of fever and other typical clinical manifestations of the disease; the need for an effectively functioning logistics system for timely hospitalization of patients with IE in Cardiovascular Centers performing surgical interventions in the acute period of IE.
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Никулина et al. (2023) conducted a case report in Infectious endocarditis of a cardiac implantable device (n=1). Cardiac implantable device (Sensia SR VVI pacemaker) was evaluated. A 51-year-old patient with a pacemaker developed infectious endocarditis, pulmonary embolism, and severe tricuspid regurgitation despite the absence of fever and typical clinical manifestations.
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