Enterococcal Prosthetic Valve Infective Endocarditis Presenting as Complete Heart Block with Intramyocardial Abscess Causing Asystolic Cardiac Arrest

Abstract

The extension of an intracardiac abscess causing complete heart block is a rare complication of infective
endocarditis that is associated with a high mortality. Early identification of conduction abnormalities
and a low threshold for suspecting infective endocarditis is crucial to provide prompt management to
prevent intracardial extension of infection. We report a case of a patient presenting with complete heart
block in the setting of profound hyperkalemia, and was then found to have enterococcal prosthetic
valve endocarditis, which was complicated by an intracardiac aortic root abscess which led to asystolic
cardiac arrest. The development of heart block in endocarditis serves as a marker for poor prognosis
and can signify progression of infection. Management therefore requires immediate pacing, antibiotic
delivery to lessen infectious burden, and evaluation for consideration of surgical options such as valve
replacement. It is therefore recommended for patients with endocarditis complicated by conduction
abnormalities or intracardial abscesses to be treated by a multi-disciplinary team consisting of
cardiologists, cardiothoracic surgeons, and infectious disease specialists.