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CPC 2018
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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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Abstract
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CLEAR FILTERS
The great simulator
Session:
Casos Clínicos
Speaker:
Cátia Costa Oliveira
Congress:
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Casos Clínicos
FP Number:
---
Authors:
Cátia Costa Oliveira; Catarina Vieira; António Coelho Gaspar; António Costeira; Nuno Antunes; Isabel Durães Campos; Carlos Galvão Braga; Paulo Medeiros; Carla Rodrigues; Jorge Marques; José Pinheiro Torres; Elson Salgueiro
Abstract
<p>A 33 years old male with a previous history of aortic valve replacement with a biologic valve 10 years ago at Brazil for infective endocarditis (IE) went to our emergency room for fever with 3 weeks of evolution. Transthoracic echocardiogram (TTE) showed severe depression of the left ventricle function (LVEF of 30 %) and highly calcified and severely dysfunctional aortic valve prosthesis. A presumptive IE diagnosis was made and patient was medicated for 4 days with empiric antibiotherapy until a transesophageal echocardiogram showed no signs of vegetations or abscesses. Hemocultures were also negative. Therefore, IE diagnosis was not confirmed. Patient started experiencing episodes of hemoptysis and a thoracic CT showed alveolar hemorrhage. Urine analysis had signs of hematuria and proteinuria. A positive ANCA PR3 title was identified suggesting a lung-kidney syndrome associated vasculitis. A kidney biopsy was made. After discussion with Internal Medicine and Nephrology and given the gravity of the clinical presentation, immunosuppression and plasmapheresis were initiated. Though hemoptysis stopped, patient kept degrading with severe heart failure. A TTE showed a LVEF of 5-10% and a LVOT VTI of 5 cm with a dysfunctional prosthesis. In this scenario, nitroprussiate de sodium infusion was started with LVOT VTI improvement. Patient was transferred to a surgical center. New thoracic CT showed not only a left atrial thrombus but also the hypothesis of IE was again suggested. Antibiotherapy was started and he was submitted to surgical aortic valve replacement. Despite macroscopic analyses of the prothesis did not showed signs of IE, <em>Bartonella</em> sp DNA was identified in blood and in the prosthesis. IE was finally confirmed (1 major criteria plus 3 minor criteria). Patient underwent 6 weeks of doxycycline with good response. A TTE showed progressive improvement of systolic function and a normofunctional aortic biologic prosthesis. Previous kidney biopsy confirmed a membranoproliferative glomerulonephritis.</p> <p><em>Bartonella</em> is a cause of "culture-negative" IE with subacute clinical course with nonspecific symptoms and immune-complex glomerulonephritis is a common feature. Involvement of prosthetic valves is associated with aggressive disease marked by rapid progression to heart failure as in this case. This case shows the difficulty on the diagnosis of culture-negative IE and highlights the high immunological events of <em>Bartonella</em> IE which can masquerade the real diagnosis.</p>
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