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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Endocarditis of native mitral valve which was presented like refractory septic shock


We showed the case of a sixty-five-year-old woman who developed refractory septic shock as a result of endocarditis of the native mitral valve with maintained neat systolic function of the left ventricle and moderate mitral regurgitation. Streptococcus sanguinis was isolated from hemoculture. The patient did not have clearly known predisposing factors for the development of endocarditis, nor had elevated temperature. She died 32 hours after being admitted to the hospital.

Key words: endocarditis, native mitral valve, refractory septic shock

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Atypical presentation of thrombosis of a permanent pacemaker lead


Pacemaker related infective endocarditis (PMIE) and pacemaker lead thrombosis (PMLT) are infrequent but potentially lethal complications of pacemaker (PM) therapy. Differences in clinical presentation, echocardiographic appearance and laboratory findings are usually helpful in making a confident diagnosis.  On the other hand, atypical clinical and echocardiographic findings may complicate their differentiation and result in a therapeutic dilemma. We present a 70-year-old man with a permanent PM hospitalized because of a 7-day history of fever and weakness. Elevated inflammatory parameters and atypical echocardiographic findings resulted in a diagnostic dilemma between PMIE and PMLT. In this paper, we discuss the pathogenesis of these entities, their clinical presentation and therapy.

Key words: echocardiography, endocarditis, pacemaker, lead, thrombosis

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