Infective endocarditis常由革蘭氏陽性菌引起..包括Streptococci, Enterococcus與Staph..

抗生素選擇其實並不難..有太多太多的文章已經提到相關議題..不需我再錦上添花..

可參考 Infective Endocarditis in Adults. N Engl J Med. 2001; 345: 1318-30.

今天讓我感到興趣的是..一位過去是教師的女性病患..因為sudden onset of consciousness distrubance及fever入院..病患數年前因為嚴重aortic stenosis做過AVR..

重點是其ECG在入院後突然出現new left bundle branch block,病患並沒有chest pain的情形..cardiac enzyme結果尚未出來..

What happened?

DDx:

- acute myocardial infarction?
- acute pulmonary embolism?
- pericardil effusion with cardiac tamponade?
- infective endocarditis?

Endocarditis有沒有可能引發conduction abnormality?事實上是有..當細菌往瓣膜以外的地方進攻時..就有可能產生這樣的問題..若吃到septum..就可能產生bundle branch block..

Infective endocarditis + conduction delay 想到paravalvular infection..要注意喔..

Adapted from N Engl J Med. 2005; 352: 709-16.