Multiple embolization in infective endocarditis

Multiple embolization in infective endocarditis Editorial 1739 7. Golwala HB, Cannon CP, Steg Ph. G, Doros G, Qamar A, Ellis SG, Oldgren J, ten a report of the American College of Cardiology/American Heart Association Task Berg JM, Kimura T, Hohnloser SH, Lip GYH, Bhatt DL. Safety and efficacy of dual Force on Clinical Practice Guidelines. Circulation 2016;134:e123–e155. vs. triple antithrombotic therapy in patients with atrial fibrillation following percu- . 9. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Juni P, Kastrati A, taneous coronary intervention: a systematic review and meta-analysis of random- Kolh P, Mauri L, Montalescot G, Neumann FJ, Petricevic M, Roffi M, Steg PG, ized clinical trials. Eur Heart J 2018;39:1726–1735. Windecker S, Zamorano JL, Levine GN. 2017 ESC focused update on dual antipla- 8. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, telet therapy in coronary artery disease developed in collaboration with EACTS: Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O’Gara PT, . The Task Force for dual antiplatelet therapy in coronary artery disease of the Sabatine MS, Smith PK, Smith SC Jr. 2016 ACC/AHA Guideline focused update on European Society of Cardiology (ESC) and of the European Association for duration of dual antiplatelet therapy in patients with coronary artery disease: Cardio-Thoracic Surgery (EACTS). Eur Heart J 2018;39:213–260. doi:10.1093/eurheartj/ehy073 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 23 February 2018 .................................................................................................................................................... 1 1 2 1 Martina Boscolo Berto *, Luigi Biasco , Stefanos Demertzis , and Giovanni Battista Pedrazzini 1 2 Department of Cardiology, Fondazione Cardiocentro Lugano, Via Tesserete 46, 6900 Lugano, Switzerland; and Department of Cardiovascular Surgery, Fondazione Cardiocentro Lugano, Via Tesserete 46, 6900 Lugano, Switzerland * Corresponding author. Tel: 141774271872, Fax: 141918116620, Email: m.boscoloberto@gmail.com A 67-year-old man presented to the emergency department with back pain, fever, and confusion. Suspecting of a meningoencephalitis, he was admitted and started on antibiotics. Vertebral MRI and lumbar puncture supported this initial hypothesis, while blood cultures resulted positive for a meticillin-sensitive Staphylococcus aureus. On Day 3, a progressive neurological decline associated with multi-organ failure needing endo-tracheal intubation become evident. Cerebral contrast MRI showed small bilateral cortical microabscesses and subarachnoid haemorrhages (Panel A). Total body CT scan detected diffuse septic pulmonary infarcts as well (Panel B). On a clinical ground, peripheral embolic lesions were clear starting as Janeway lesions and evolving in diffuse finger’s necrosis (Panel C). Roth’s spots retinal haemorrhages were evident. Transoesophageal echocardiography confirmed a vegetation of the mitral valve (Panel D) that was interpreted as the original septic focus. Surgical valve replacement was indicated as urgent treatment and prolonged antibiotic therapy with floxapen is ongoing. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/19/1739/4907931 by Ed 'DeepDyve' Gillespie user on 21 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

Multiple embolization in infective endocarditis

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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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Abstract

Editorial 1739 7. Golwala HB, Cannon CP, Steg Ph. G, Doros G, Qamar A, Ellis SG, Oldgren J, ten a report of the American College of Cardiology/American Heart Association Task Berg JM, Kimura T, Hohnloser SH, Lip GYH, Bhatt DL. Safety and efficacy of dual Force on Clinical Practice Guidelines. Circulation 2016;134:e123–e155. vs. triple antithrombotic therapy in patients with atrial fibrillation following percu- . 9. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Juni P, Kastrati A, taneous coronary intervention: a systematic review and meta-analysis of random- Kolh P, Mauri L, Montalescot G, Neumann FJ, Petricevic M, Roffi M, Steg PG, ized clinical trials. Eur Heart J 2018;39:1726–1735. Windecker S, Zamorano JL, Levine GN. 2017 ESC focused update on dual antipla- 8. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, telet therapy in coronary artery disease developed in collaboration with EACTS: Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O’Gara PT, . The Task Force for dual antiplatelet therapy in coronary artery disease of the Sabatine MS, Smith PK, Smith SC Jr. 2016 ACC/AHA Guideline focused update on European Society of Cardiology (ESC) and of the European Association for duration of dual antiplatelet therapy in patients with coronary artery disease: Cardio-Thoracic Surgery (EACTS). Eur Heart J 2018;39:213–260. doi:10.1093/eurheartj/ehy073 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 23 February 2018 .................................................................................................................................................... 1 1 2 1 Martina Boscolo Berto *, Luigi Biasco , Stefanos Demertzis , and Giovanni Battista Pedrazzini 1 2 Department of Cardiology, Fondazione Cardiocentro Lugano, Via Tesserete 46, 6900 Lugano, Switzerland; and Department of Cardiovascular Surgery, Fondazione Cardiocentro Lugano, Via Tesserete 46, 6900 Lugano, Switzerland * Corresponding author. Tel: 141774271872, Fax: 141918116620, Email: m.boscoloberto@gmail.com A 67-year-old man presented to the emergency department with back pain, fever, and confusion. Suspecting of a meningoencephalitis, he was admitted and started on antibiotics. Vertebral MRI and lumbar puncture supported this initial hypothesis, while blood cultures resulted positive for a meticillin-sensitive Staphylococcus aureus. On Day 3, a progressive neurological decline associated with multi-organ failure needing endo-tracheal intubation become evident. Cerebral contrast MRI showed small bilateral cortical microabscesses and subarachnoid haemorrhages (Panel A). Total body CT scan detected diffuse septic pulmonary infarcts as well (Panel B). On a clinical ground, peripheral embolic lesions were clear starting as Janeway lesions and evolving in diffuse finger’s necrosis (Panel C). Roth’s spots retinal haemorrhages were evident. Transoesophageal echocardiography confirmed a vegetation of the mitral valve (Panel D) that was interpreted as the original septic focus. Surgical valve replacement was indicated as urgent treatment and prolonged antibiotic therapy with floxapen is ongoing. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/19/1739/4907931 by Ed 'DeepDyve' Gillespie user on 21 June 2018

Journal

European Heart JournalOxford University Press

Published: Feb 23, 2018

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