Myocardial Abscess Follow-up
- Author: Vibhuti N Singh, MD, MPH, FACC, FSCAI; Chief Editor: Burke A Cunha, MD more...
Further Inpatient Care
- Aggressive postoperative supportive therapy in patients with myocardial abscess includes the following:
- Agents for stabilization of hemodynamics
- Fluid and electrolyte balance
- Nutrition (parenteral or enteral)
- Continuation of antibiotic therapy may be necessary. Patients may still require a prolonged 6-week course of antibiotic therapy.
Further Outpatient Care
- Continuation of adjunctive therapy
- Anticoagulation therapy, in case of metallic prosthetic valve replacement
- Continuing antibiotic therapy
- Diuretic use with CHF
- Antiarrhythmic therapy for postoperative arrhythmias
- Aggressive antibiotic prophylaxis prior to minor surgeries
Inpatient & Outpatient Medications
- Vancomycin
- Gentamicin
- Dopamine
- Diuretics
- Anticoagulants
Transfer
- Patients with infective endocarditis usually exhibit rapid deterioration, and they may require transfer to a tertiary care facility for a diagnostic workup and open heart surgery. Such patients must be transported via an Advanced Cardiac Life Support ambulance staffed with well-trained and experienced paramedics.
Deterrence/Prevention
- Prompt and effective treatment of infective endocarditis is required.
- A high index of suspicion and early recognition of the changes that suggest development of myocardial abscess are necessary.
- Regular prophylaxis for subacute bacterial endocarditis, with preoperative antibiotics according to the recommendations of the American Heart Association, is necessary.
- Critically ill patients with myocardial abscess and infective endocarditis are usually bedridden, with minimal activity. Frequently, such patients must receive prophylaxis to prevent development of DVT and PE.
Complications
- Myocardial perforation
- Significant clinical deterioration
- Worsening CHF
- Worsening heart sounds and murmurs
- New-onset valvular regurgitation (100% of cases)[11]
- Poor response to antibiotics
- Development of conduction defects or progression of heart block, such as bundle-branch block and atrioventricular block (45%)[2]
- Sudden onset of complete heart block or Mobitz type II block (highly specific)
- Type of valve involvement, eg, aortic valve endocarditis (40%-85%)
- Miscellaneous
- Severe recurrent ventricular arrhythmias
- Pericarditis (uncommon)
- Infection of the prosthetic valves
- Right-sided endocarditis in patients with congenital heart disease
Prognosis
- With early diagnosis and prompt surgical treatment, patients improve rapidly.
- Without surgical intervention, the prognosis worsens very significantly.
Patient Education
- Educate patients regarding their condition, and emphasize the importance of prophylaxis.
- For excellent patient education resources, visit eMedicine's Infections Center and Heart Center. Also, see eMedicine's patient education articles Abscess and Antibiotics.
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