Myocardial Abscess Follow-up

Updated: Jan 28, 2015
  • Author: Vibhuti N Singh, MD, MPH, FACC, FSCAI; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Follow-up

Further Outpatient Care

Further outpatient care may include the following:

  • 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
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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.

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Inpatient & Outpatient Medications

These include the following:

  • Vancomycin
  • Gentamicin
  • Dopamine
  • Diuretics
  • Anticoagulants
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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.

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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.

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Complications

The following are potential complications of myocardial abscess:

  • 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)
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Prognosis

With early diagnosis and prompt surgical treatment, patients improve rapidly.

Without surgical intervention, the prognosis worsens very significantly.

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Patient Education

Educate patients regarding their condition, and emphasize the importance of prophylaxis.

For excellent patient education resources, visit eMedicineHealth's Infections Center and Heart Health Center. Also, see eMedicineHealth's patient education articles Skin Abscess and Antibiotics.

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