A myocardial abscess is a suppurative infection located in the endocardium or myocardium, that may involve the heart conduction system, valvular apparatus or neighboring structures, most often caused by infective endocarditis or septicemia. This condition is potentially life-threatening, making an early diagnosis and therapy mandatory.
In septic conditions, myocardial abscess symptoms may be concealed by signs of infection of other organs. The presence of a myocardial abscess is suggested by clinical deterioration and abnormal heart rhythm in a patient suspected of infectious endocarditis. This latter entity is associated with new or altered heart murmurs , acute or aggravated chronic heart failure signs and little or no response to antibiotics. Abrupt development of complete or Mobitz II heart block, conduction defects  or severe ventricular arrhythmias strongly suggest a myocardial abscess. This should also be suspected in sepsis along with the development of an acute myocardial infarction or in those with penetrating chest injuries. Most individuals are febrile and have chills and sweats but severely debilitated, chronic kidney disease or elderly individuals may have normal temperature. Additional symptoms include lack of appetite with weight loss, malaise , respiratory symptoms like a cough and dyspnea, general findings like as myalgia, arthralgia, confusion, headache or abdominal pain.
Patients are generally tachycardic and exhibit peripheral endocarditis manifestations: Osler nodes, Roth spots, Janeway lesions, petechiae, splenomegaly, clubbing and embolic events, especially neurologic, renal and pulmonary. If the aortic valve is involved, pulse pressure will be wide because of the valvular regurgitation. Catastrophic heart wall rupture, although infrequent, is possible , as is the presence of multiple, remote abscesses , as opposed to lesions resulting from direct extension from an infected structure, usually valvular .
Entire Body System
Fever, chills and signs of pericarditis were the main clinical features. Mild enteritis 1 week prior to the onset of symptoms related to the abscess was the most likely cause of the bacteremia. [ncbi.nlm.nih.gov]
One week after extubation, he suddenly developed fever and disturbance of consciousness. Candida albicans was detected from blood and cerebrospinal fluid culture. [keio.pure.elsevier.com]
- Congestive Heart Failure
New to the third edition are: - Expanded coverage of the coronary heart disease syndromes; congestive heart failure; arrhythmias; pacing; sudden death; lipid management (including clinical results), and a completely revised and updated section on noninvasive [books.google.com]
Moore PT, Proto AV (1984) Juxtacardiac mass and congestive heart failure. Chest 86(1):95–96 PubMed Google Scholar 10. Escarous A (1989) CT findings of a posterior false aneurysm of the left ventricle (letter). [link.springer.com]
Evidence of congestive heart failure. New conduction disturbance. Vascular or immunological phenomena: embolic event, Roth's spots, splinter haemorrhages, Janeway's lesions, Osler's nodes. A new stroke. [patient.info]
A S3 gallop indicates left-sided congestive heart failure. [atsu.edu]
This may also result in hematogenous seeding and disseminated tuberculosis. 9 Clinically, tuberculomas may be asymptomatic or may present with arrhythmias, 5 complete heart block, 8, 10 congestive heart failure, 11 superior vena caval obstruction, 12 [cmaj.ca]
A 63-year-old woman with aplastic anaemia was admitted to hospital for fever and malaise. Computed tomography (CT) scan showed a cavitary nodular lesion in the left lower lobe, which was highly suspicious for pulmonary aspergilloma (Figure 1A-1). [emvmsa1a.jouve-hdi.com]
Additional symptoms include lack of appetite with weight loss, malaise, respiratory symptoms like a cough and dyspnea, general findings like as myalgia, arthralgia, confusion, headache or abdominal pain. [symptoma.com]
Case presentation A 28-year-old intravenous drug user was admitted in a district general hospital with a 2-week history of fever, malaise and myalgia. He had no past medical history of note. [jmedicalcasereports.biomedcentral.com]
Other signs and symptoms include the following: Anorexia Weight loss Malaise Dyspnea Cough Stroke Headache Nausea/vomiting Myalgia Arthralgia Chest pain Abdominal pain Back pain Confusion Sweats Physical Physical examination findings commonly encountered [emedicine.medscape.com]
[…] endocarditis include congenital heart disease, rheumatic heart disease, IV drug use, degenerative valve disease and intracardiac devices. ,  Clinical manifestations of infective endocarditis include high grade fever, chills, sweating, anorexia, malaise [jcecho.org]
- Fever of Unknown Origin
A 73 year old male was hospitalised with fever of unknown origin and episodes with septic shock. During the in-hospital stay the clinical situation deteriorated rapidly, and E. coli was isolated from bloodcultures. [ncbi.nlm.nih.gov]
Kradin is also an Associate Pathologist at Massachusetts General Hospital in the Immunopathology Unit. His techniques include tissue culture and immunocytochemistry, flow cytometry, Northern blotting and immunocytochemistry. Dr. [books.google.com]
- Heart Disease
The relative incidence of myocardial abscesses occurring in the presence of acute or chronic ischemic heart disease is unknown. [ncbi.nlm.nih.gov]
Presents comprehensive coverage of valvular heart disease to provide you with a complete reference and one-stop shop for this specialty in cardiac medicine. [books.google.com]
CASE REPORT A 46 year old Italian male barber, with the diagnosis of inactive rheumatic heart disease, had been followed for a long period. [annals.org]
Revel D, Higgins CB (1985) Magnetic resonance imaging of ischemic heart disease. Radiol Clin North Am 23(4):719–726 PubMed Google Scholar 13. Bradley WG (1988) Flow phenomenon in MR imaging. AJR 150:983–994 PubMed Google Scholar 14. [link.springer.com]
- Ejection Murmur
There was a systolic ejection murmur (grade 2/6) and a diastolic murmur (grade 4/6) in the aortic area. There was a moderate pain-ful splenomegaly. The lungs were clear and there was no peripheral edema. [romanianjournalcardiology.ro]
- Cardiac Signs and Symptoms
The book and DVD package is designed to provide comprehensive coverage of every aspect of cardiovascular medicine from cardiac signs and symptoms and the full range of cardiac imaging techniques through management of peripheral vascular disease and the [books.google.com]
Blood workup in myocardial abscess should include a complete cell blood count, that will highlight the presence of leukocytosis with granulocytosis and inflammatory, normochromic, normocytic anemia. Serum iron level and iron binding capacity are diminished. Low platelet numbers are possible. A complete chemistry panel is useful in order to determine renal and hepatic status at the moment of presentation. Myocardial abscesses are frequently accompanied by azotemia. Inflammatory markers are increased in most patients, with an erythrocyte sedimentation rate of about 55 mm/h. Blood cultures are indispensable and should optimally be obtained before antibiotic therapy is started. Microscopic hematuria and proteinuria are not infrequent.
Chest radiography is only useful in order to assess pulmonary status and cardiac silhouette, which may serve as an indicator for chronic heart failure. Although it has a low sensitivity, a transthoracic echocardiogram is mandatory in order to evaluate heart morphology especially that of the valves, the presence of regurgitations and contractility. A myocardial abscess, although it may not be visible itself, is suggested by the presence of an echo-free space inside the myocardial mass, rocking of prosthetic valves, septum perivalvular density with a diameter that exceeds 14 mm and aneurysmal dilatation of a Valsalva sinus . Real-time 3-dimensional contrast transthoracic echography offers in some cases a reliable description of the pathological process , as do transesophageal echocardiography , Indium-In 111 leukocyte scintigraphy and magnetic resonance imaging . However, some cases remain undiagnosed until surgery is performed.
The electrocardiogram often offers little information, but in some patients, gradual PR prolongation or new conduction abnormalities have been described. A cardiac catheterization is only employed in cases that are going to be referred for surgery so that coronary artery disease is confirmed or excluded.
- Erythrocyte Sedimentation Rate Increased
sedimentation rate, increased levels of C-reactive protein in the blood, leukocytosis in a complete blood count Prolonged P-R interval in electrocardiograph (EKG) *The presence of 2 major criteria or 1 major and 2 minor criteria, indicates a high probability [atsu.edu]
- Mycobacterium Fortuitum
A case of pacemaker infection complicated by bacteremia and myocardial abscess caused by Mycobacterium fortuitum is reported and 9 other cases of pacemaker infection associated with rapidly growing mycobacteria are reviewed. [ncbi.nlm.nih.gov]
Myocardial abscess and bacteremia complicating Mycobacterium fortuitum pacemaker infection: case report and review of the literature. [biomedsearch.com]
- Erysipelothrix Rhusiopathiae
Valvular and myocardial abscesses due to Erysipelothrix rhusiopathiae. Clin Infect Dis. 1999. 29(5):1351-2. [Medline]. Persaud H, Pande PN, Easley JM Jr, Downing TP. Myocardial abscess complicating acute myocardial infarction. [emedicine.medscape.com]
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- Vega Moller D, Eske Bruun N. Substantial Myocardial Abscess in an Immunocompromised Patient: Fatal Outcome After Coagulase-negative Staphylococcal Native Valve Infection. JASE. 2007;20(3):333.e5–333.e8.
- Khan B, Strate RW, Hellman R. Myocardial abscess and fatal cardiac arrhythmia in a hemodialysis patient with an arterio-venous fistula infection. Semin Dial. 2007;20(5):452-4.
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- Anguera I, Quaglio G, Ferrer B, et al. Sudden death in Staphylococcus aureus-associated infective endocarditis due to perforation of a free-wall myocardial abscess. Scand J Infect Dis. 2001;33(8):622–5.
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- Walker N, Bhan A, Desai J, et al. Myocardial abscess: a rare complication of valvular endocarditis demonstrated by 3D contrast echocardiography. Eur J Echocardiogr. 2010;11(10): E37.
- Hill EE, Herijgers P, Claus P, et al. Abscess in infective endocarditis: The value of transesophageal echocardiography and outcome: A 5-year study. Am H Journ. 2007;154: 923-8.
- Reynier C, Garcier J, Legault B, et al. Cross-sectional imaging of post endocarditis paravalvular myocardial abscesses of native mitral valves: 4 cases. J Radiol. 2001;82: 665-9.
- Day MD, Gauvreau K, Shulman S, et al. Characteristics of children hospitalized with infective endocarditis. Circulation. 2009;119(6):865-70.
- Gaur L, Madan S, Morell V, et al. Formation of ventricular aneurysm after endocarditis in a child with methicillinresistant Staphylococcus aureus (MRSA) bacteremia. Pediatr Cardiol. 2011;32(7):1062-4.