Question 105 · LEK · Infective endocarditis
A 75-year-old patient comes to the cardiology outpatient clinic because of the aggravation of the right ventricular failure. He has an ischemic cardiomyopathy and had a biventricular cardioverter defibrillator implanted 5 years ago. The patient complains of recurrent fever and lower respiratory tract infections for the last 6 months. Indicate the correct management:
- A. at present the patient needs no further cardiac diagnostics, a pulmonologist consultation is urgently needed.
- B. after excluding a vegetation with the transthoracic echocardiogram the treatment of the heart failure should be intensified, and the patient needs no further cardiac diagnostics.
- C. transthoracic and transesophageal echocardiograms should be performed as the infectious endocarditis is suspected.
- D. absence of pacemaker pocket infection signs excludes electrode lead endocarditis so the only needed interventions are the pacemaker checkup and the intensification of heart failure treatment.
- E. antibiotic prophylaxis of electrode lead endocarditis should be started and the treatment of the heart failure should be intensified.
Hint
Recurrent fevers and chest infections in a patient with transvenous leads should make you think about what may be happening on the right-sided leads.
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