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Myocardial Abscess Medication

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

Medication Summary

Even though the main mode of treatment is surgical, patients with myocardial abscess still require antibiotics and adjunct agents for stabilization of hemodynamic status (ie, pressors).



Class Summary

These agents are used to treat susceptible organisms, especially Staphylococcus species, which are the most common organisms in myocardial abscesses.

Vancomycin (Lyphocin, Vancoled, Vancocin)


Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Useful in treatment of septicemia and skin structure infections. Indicated for patients who cannot receive or have not responded to penicillins and cephalosporins or those who have infections with resistant staphylococci. For abdominal penetrating injuries, combine with an agent active against enteric flora and/or anaerobes. To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing. Use CrCl to adjust dose in patients diagnosed with renal impairment. Used in conjunction with gentamicin for prophylaxis in patients allergic to penicillin who are undergoing GI or GU procedures.

Gatifloxacin (Tequin)


Fluoroquinolone with antimicrobial activity based on ability to inhibit bacterial DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Fluoroquinolones have broad activity against gram-positive and gram-negative aerobic organisms. Differences in chemical structure between quinolones have resulted in altered levels of activity against different bacteria. Altered chemistry in quinolones results in toxicity differences.

Gentamicin (Garamycin)


Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes.

Not DOC. Consider if penicillins or other less-toxic drugs are contraindicated, when clinically indicated, and in mixed infections caused by susceptible staphylococci and gram-negative organisms.

Dosing regimens are numerous; adjust dose based on CrCl and changes in volume of distribution. May be given IV/IM.

Levofloxacin (Levaquin)


For pseudomonal infections and infections due to multidrug-resistant gram-negative organisms.



Class Summary

These agents are used to raise blood pressure and improve tissue perfusion in patients with septic shock or hypotension.

Dopamine (Intropin)


Stimulates both adrenergic and dopaminergic receptors. Hemodynamic effect dependent on dose. Lower doses predominantly stimulate dopaminergic receptors, which, in turn, produce renal and mesenteric vasodilation. Cardiac stimulation and renal vasodilation produced by higher doses.

After initiating therapy, increase dose by 1-4 mcg/kg/min q10-30min until optimal response is obtained. More than 50% of patients are maintained satisfactorily on doses < 20 mcg/kg/min.



Class Summary

Antithrombin and anticoagulant agents may be needed for prevention of DVT. Anticoagulants are required for stroke prevention after replacement of cardiac valves with mechanical prostheses.



Augments activity of antithrombin III and prevents conversion of fibrinogen to fibrin. Does not actively lyse but is able to inhibit further thrombogenesis. Prevents reaccumulation of clot after spontaneous fibrinolysis.

Warfarin (Coumadin)


Interferes with hepatic synthesis of vitamin K – dependent coagulation factors. Used for prophylaxis and treatment of DVT, PE, and thromboembolic disorders. Tailor dose to maintain INR in range of 2-3.

Contributor Information and Disclosures

Vibhuti N Singh, MD, MPH, FACC, FSCAI Clinical Assistant Professor, Division of Cardiology, University of South Florida College of Medicine; Director, Cardiology Division and Cardiac Catheterization Lab, Chair, Department of Medicine, Bayfront Medical Center, Bayfront Cardiovascular Associates; President, Suncoast Cardiovascular Research

Vibhuti N Singh, MD, MPH, FACC, FSCAI is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, Florida Medical Association

Disclosure: Nothing to disclose.


Jamshid Shirani, MD Director of Cardiology Fellowship Program, Director of Echocardiography Laboratory, Director of Hypertrophic Cardiomyopathy Clinic, St Luke's University Health Network

Jamshid Shirani, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society of Echocardiography, Association of Subspecialty Professors, American College of Cardiology, American College of Physicians, American Heart Association

Disclosure: Nothing to disclose.

Mingquan Suksanong Clinical Assistant Professor, Department of Medicine, Division of Infectious Diseases and Tropical Medicine, University of South Florida College of Medicine; Consulting Staff, Department of Medicine, Bayfront Medical Center

Disclosure: Nothing to disclose.

Joel A Strom, MD, ME Adjunct Clinical Professor of Medicine, University of Florida College of Medicine

Joel A Strom, MD, ME is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American Heart Association, American Society of Echocardiography

Disclosure: Received own stock from Merck, Inc. for none; Received own stock from Abbott Labs, Inc. for none; Partner received own stock from Medtronic for none; Received own stock from General Electric for none; Received own stock from Pfizer, Inc. for other.

Kul Aggarwal, MD, FACC Professor of Clinical Medicine, Department of Internal Medicine, Division of Cardiology, University of Missouri-Columbia School of Medicine; Chief, Cardiology Section, Harry S Truman Veterans Hospital

Kul Aggarwal, MD, FACC is a member of the following medical societies: American College of Cardiology, American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Craig T Basson, MD, PhD Translational Medicine Head – Cardiovascular, Translational Medicine Head - Diabetes and Metabolism, Novartis Institutes for BioMedical Research

Craig T Basson, MD, PhD is a member of the following medical societies: American College of Cardiology, American Heart Association

Disclosure: Nothing to disclose.


Rakesh K Sharma, MD, FACC Adjunct Associate Professor of Medicine and Cardiology, Medical Center of South Arkansas , University of Arkansas for Medical Sciences

Rakesh K Sharma, MD, FACC is a member of the following medical societies: American College of Cardiology, American College of International Physicians, American College of Physicians, American Heart Association, and American Medical Association

Disclosure: Nothing to disclose.

  1. Cossio P, Berconsky I. Abceso parietal del corazon e infarto del myocardio. Seman Med. 1933. 2:1691-8.

  2. Gonzalez Vilchez FJ, Martin Duran R, Delgado Ramis C, et al. [Active infective endocarditis complicated by paravalvular abscess. Review of 40 cases]. Rev Esp Cardiol. 1991 May. 44(5):306-12. [Medline].

  3. Sanson J, Slodki S, Gruhn JG. Myocardial abscesses. Am Heart J. 1963 Sep. 66:301-8. [Medline].

  4. Castleman B, McNeely BU. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 27-1970. N Engl J Med. 1970 Jun 25. 282(26):1477-85. [Medline].

  5. Weisz S, Young DG. Myocardial abscess complicating healed myocardial infarction. Can Med Assoc J. 1977 May 21. 116(10):1156-8. [Medline].

  6. Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG Jr, Bayer AS. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009 Mar 9. 169(5):463-73. [Medline].

  7. van der Meer JT, Thompson J, Valkenburg HA, Michel MF. Epidemiology of bacterial endocarditis in The Netherlands. II. Antecedent procedures and use of prophylaxis. Arch Intern Med. 1992 Sep. 152(9):1869-73. [Medline].

  8. Hogevik H, Olaison L, Andersson R, et al. Epidemiologic aspects of infective endocarditis in an urban population. A 5-year prospective study. Medicine (Baltimore). 1995 Nov. 74(6):324-39. [Medline].

  9. Dismukes WE, Karchmer AW, Buckley MJ, et al. Prosthetic valve endocarditis. Analysis of 38 cases. Circulation. 1973 Aug. 48(2):365-77. [Medline].

  10. Ben Ismail M, Hannachi N, Abid F, et al. Prosthetic valve endocarditis. A survey. Br Heart J. 1987 Jul. 58(1):72-7. [Medline].

  11. Arnett EN, Roberts WC. Valve ring abscess in active infective endocarditis. Frequency, location, and clues to clinical diagnosis from the study of 95 necropsy patients. Circulation. 1976 Jul. 54(1):140-5. [Medline].

  12. Ellis SG, Goldstein J, Popp RL. Detection of endocarditis-associated perivalvular abscesses by two- dimensional echocardiography. J Am Coll Cardiol. 1985 Mar. 5(3):647-53. [Medline].

  13. Walker N, Bhan A, Desai J, Monaghan MJ. Myocardial abscess: a rare complication of valvular endocarditis demonstrated by 3D contrast echocardiography. Eur J Echocardiogr. 2010 Dec. 11(10):E37. [Medline].

  14. Adachi I, Kobayashi J, Nakajima H. Coronary embolism and subsequent myocardial abscess complicating ventricular aneurysm and tachycardia. Ann Thorac Surg. 2005 Dec. 80(6):2366-8. [Medline].

  15. Adams BK. Tc-99m leukocyte scintigraphy in infective endocarditis. Clin Nucl Med. 1995 May. 20(5):395-7. [Medline].

  16. Aguado JM, Gonzalez-Vilchez F, Martin-Duran R, et al. Perivalvular abscesses associated with endocarditis. Clinical features and diagnostic accuracy of two-dimensional echocardiography. Chest. 1993 Jul. 104(1):88-93. [Medline].

  17. Ait Ben Ali S, Hilmani S, Choukri M, et al. [Multiple cerebral hydatic cysts of cardiac origin. A case report]. Neurochirurgie. 1999 Dec. 45(5):426-9. [Medline].

  18. Almond DS, Lea BI, Saltissi S, et al. Interventricular septal abscess formation in an HIV-positive man. Int J STD AIDS. 1999 Nov. 10(11):749-50. [Medline].

  19. Antonov VA. [Electric alternation of the heart in myocardial abscesses]. Kardiologiia. 1991 Jul. 31(7):49-50. [Medline].

  20. Arruabarrena IM, Von Wichmann MA, Iribarren JA, et al. [Favorable evolution of a myocardial abscess using medical treatment in an HIV-positive patient]. Enferm Infecc Microbiol Clin. 1998 Mar. 16(3):156. [Medline].

  21. Bajraktari G, Olloni R, Daullxhiu I, Ademaj F, Vela Z, Pajaziti M. MRSA endocarditis of bovine Contegra valved conduit: a case report. Cases J. 2009. 2(1):57. [Medline].

  22. Balaguer JM, Soto E, Perry D, Moran JM. Postoperative intramyocardial abscess caused by mucormycosis. Ann Thorac Surg. 1994 Dec. 58(6):1760-2. [Medline].

  23. Bayer AS, Bolger AF, Taubert KA, et al. Diagnosis and management of infective endocarditis and its complications. Circulation. 1998 Dec 22-29. 98(25):2936-48. [Medline]. [Full Text].

  24. Behnam R, Walter S, Hanes V. Myocardial abscess complicating myocardial infarction. J Am Soc Echocardiogr. 1995 May-Jun. 8(3):334-7. [Medline].

  25. Berman DA, Burgess JB, Steeper TA. Myocardial abscess due to Fusobacterium following acute myocardial infarction. Clin Cardiol. 1988 Aug. 11(8):575-7. [Medline].

  26. Borowski A, Korb H, Voth E, de Vivie ER. Asymptomatic myocardial abscess. Thorac Cardiovasc Surg. 1988 Dec. 36(6):338-40. [Medline].

  27. Cerqueira MD, Jacobson AF. Indium-111 leukocyte scintigraphic detection of myocardial abscess formation in patients with endocarditis. J Nucl Med. 1989 May. 30(5):703-6. [Medline].

  28. Chakrabarti J. Diagnostic evaluation of myocardial abscesses. A new look at an old problem. Int J Cardiol. 1995 Dec. 52(3):189-96. [Medline].

  29. Chang CH, Huang JY, Lai PC, Yang CW. Posterior mediastinal abscess in a hemodialysis patient - a rare but life-threatening complication of Staphylococcus bacteremia. Clin Nephrol. 2009 Jan. 71(1):92-5. [Medline].

  30. Chikwe J, Barnard J, Pepper JR. Myocardial abscess. Heart. 2004 Jun. 90(6):597. [Medline].

  31. Cowan JC, Patrick D, Reid DS. Aortic root abscess complicating bacterial endocarditis. Demonstration by computed tomography. Br Heart J. 1984 Nov. 52(5):591-3. [Medline].

  32. Dajani AS, Taubert KA, Wilson W. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. Available at JAMA. 1997 Jun 11. 277(22):1794-801. [Medline].

  33. Daniel WG, Nellessen U, Schroeder E. Trans-esophageal echocardiography as a method of choice for the detection of endocarditis-associated abscess. Circulation. 1986. 74(Supl II):55.

  34. Dean JW, Kuo J, Wood AJ. Myocardial infarction due to coronary artery compression by aortic root abscess. Int J Cardiol. 1993 Sep. 41(2):165-7. [Medline].

  35. Egan TM, Maitland A, Sinave C, et al. Myocardial abscess in a patient with AIDS-related complex: pericardial patch repair. Ann Thorac Surg. 1990 Mar. 49(3):481-2. [Medline].

  36. Eicher JC, Falcon-Eicher S, Sota FX, et al. Mitral ring abscess caused by bacterial endocarditis on a heavily calcified mitral annulus fibrosus: Diagnosis by multiplane transesophageal echocardiography. Am Heart J. 1996 Apr. 131(4):818-20. [Medline].

  37. Fan CC, Andersen BR, Sahgal S. Isolated myocardial abscess causing coronary artery rupture and fatal hemopericardium. Arch Pathol Lab Med. 1994 Oct. 118(10):1023-5. [Medline].

  38. Fredenrich A, Jourdan J, Gibelin P, et al. [Ventricular arrhythmias disclosing myocardial abscess in infectious mitro-aortic endocarditis]. Ann Cardiol Angeiol (Paris). 1990 Nov. 39(9):531-3. [Medline].

  39. Ghani M, Boughner D. Echocardiographic diagnosis of myocardial abscess complicating myocardial infarction. J Am Soc Echocardiogr. 1994 May-Jun. 7(3 Pt 1):318-20. [Medline].

  40. Gladden JR. Myocardial abscess with perforation of the heart following Staphylococcal pyemia. Clin Orthop. 1999. 362:6-11. [Medline].

  41. Gunther HU, Strupp G, Volmar J, et al. [Coronary stent implantation: infection and abscess with fatal outcome]. Z Kardiol. 1993 Aug. 82(8):521-5. [Medline].

  42. Harris DG, Rossouw GJ. Myocardial abscess with contained rupture: successful repair. Ann Thorac Surg. 2001. 71(4):1360-1. [Medline].

  43. Iqbal J, Ahmed I, Baig W. Metastatic myocardial abscess on the posterior wall of the left ventricle: a case report. J Med Case Reports. 2008. 2:258. [Medline].

  44. Katz A. Abscess of the myocardium complicating infarction: report of two cases. Can Med Assoc J. 1964 Dec 5. 91:1225-7. [Medline].

  45. Khoo DE, Zebro TJ, English TA. Bacterial endocarditis in a transplanted heart. Pathol Res Pract. 1989 Oct. 185(4):445-7. [Medline].

  46. Kortleve JW, Duren DR, Becker AE. Cardiac aneurysm complicated by Salmonella abscess. A clinicopathologic correlation in two patients. Am J Med. 1980 Mar. 68(3):395-400. [Medline].

  47. Kurland S, Enghoff E, Landelius J, et al. A 10-year retrospective study of infective endocarditis at a university hospital with special regard to the timing of surgical evaluation in S. viridans endocarditis. Scand J Infect Dis. 1999. 31(1):87-91. [Medline].

  48. [Guideline] Little J. The American Heart Association's guidelines for the prevention of bacterial endocarditis: a critical review. Gen Dent. 1998 Sep-Oct. 46(5):508-15. [Medline].

  49. Lo SS, Ong YE, Sheppard MN, et al. Streptococcal mural endocarditis and myocardial abscess occurring in a left ventricular aneurysm--case report and review. Clin Cardiol. 1998 Jun. 21(6):435-8. [Medline].

  50. Massachusetts General Hospital. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 46-1989. A 52-year-old diabetic man with myocardial infarction, pericarditis, and persistent fever. N Engl J Med. 1989 Nov 16. 321(20):1391-402. [Medline].

  51. McIlwaine L, Stott S, Hogg D. Fatal unruptured myocardial abscesses. Available at Heart. 2000 May. 83(5):498. [Medline].

  52. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001 Nov 1. 345(18):1318-30. [Medline].

  53. Nandish S, Khardori N. Valvular and myocardial abscesses due to Erysipelothrix rhusiopathiae. Clin Infect Dis. 1999. 29(5):1351-2. [Medline].

  54. Persaud H, Pande PN, Easley JM Jr, Downing TP. Myocardial abscess complicating acute myocardial infarction. N Y State J Med. 1988 Jan. 88(1):38-9. [Medline].

  55. Prunier L, Lavergne T, Perier P, et al. [Recurrent myocardial abscess during Streptococcus B endocarditis]. Arch Mal Coeur Vaiss. 1988 Jul. 81(7):925-8. [Medline].

  56. Recio J, Alegre J, Fernandez de Sevilla T. Myocardial abscess with salmonella infection. Ann Intern Med. 1999 Sep 21. 131(6):477-8. [Medline].

  57. Roberts JH, Aponte V, Naidich DP, Bhalla M. Myocardial abscess resulting in a pseudoaneurysm: case report. Cardiovasc Intervent Radiol. 1991 Sep-Oct. 14(5):307-10. [Medline].

  58. Romero-Menor C, Espanol I, Alcaide F, et al. Myocardial abscess at a distant zone from the active valvular infection. J Cardiovasc Surg (Torino). 1998 Apr. 39(2):227-8. [Medline].

  59. Rosen JM, Murthy S, Hain DR. A comparison of indium-111 leukocyte and gallium-67 scintigraphy in a patient with a myocardial abscess. Clin Nucl Med. 1993 Nov. 18(11):997-8. [Medline].

  60. Ryon DS, Pastor BH, Myerson RM. Abscess of the myocardium. Am J Med Sci. 1966 Jun. 251(6):698-705. [Medline].

  61. Sheppard RC, Chandrasekaran K, Ross J, Mintz GS. An acquired interatrial fistula secondary to para-aortic abscess documented by transesophageal echocardiography. J Am Soc Echocardiogr. 1991 May-Jun. 4(3):271-6. [Medline].

  62. Smith RE, Martin JE, Mills PG. Myocardial abscess and sternal osteomyelitis following myocardial infarction and resuscitation. Postgrad Med J. 1989 Aug. 65(766):589-90. [Medline]. [Full Text].

  63. Sproule MW, Briggs MJ. Salmonellosis complicated by myocardial abscess and cerebral mycotic aneurysms. Br J Clin Pract. 1995 Sep-Oct. 49(5):273-4. [Medline].

  64. Tedeschi CG, Stevenson TD Jr, Levenson HM. Abscess formation in myocardial infarction. N Engl J Med. 1950 Dec 28. 243(26):1024-7. [Medline].

  65. Tennant R, Parks HW. Myocardial abscesses. A study of pathogenesis with report of a case. Arch Pathol. 1959 Oct. 68:456-60. [Medline].

  66. Terry SM, Ryan PE Jr. Penetrating mitral valve annular abscess. J Heart Valve Dis. 1997 Nov. 6(6):621-4. [Medline].

  67. Thomas D, Choussat R, Isnard R, et al. [Cardiac abscess in infectious endocarditis. A multicenter study apropos of 233 cases. The Working Group on Valvulopathy of the French Society of Cardiology]. Arch Mal Coeur Vaiss. 1998 Jun. 91(6):745-52. [Medline].

  68. Thomas D, Desruennes M, Jault F, et al. [Cardiac and extracardiac abscesses in bacterial endocarditis]. Arch Mal Coeur Vaiss. 1993 Dec. 86(12 Suppl):1825-35. [Medline].

  69. Timsit JF, Wolff MA, Bedos JP, et al. Cardiac abscess following percutaneous transluminal coronary angioplasty. Chest. 1993 Feb. 103(2):639-41. [Medline].

  70. Valencia ME, Guinea J, Moreno V, González Lahoz JM. [Myocardial abscess without concomitant valve lesion and parenteral drug addiction]. Rev Clin Esp. 1992 Oct. 191(5):289. [Medline].

  71. Vinereanu D, Musumeci F, Fraser AG. Diagnosis of Myocardial Abscess After Acute Myocardial Infarction by Transesophageal Echocardiography: Case Report and Short Review of Published Data. Echocardiography. 1999 Aug. 16(6):581-584. [Medline].

  72. Völker U, Kraft P. [An unusual cause of myocardial infarct. Bacterial mitral valve endocarditis, valve ring and myocardial abscess with direct coronary lesion]. Z Kardiol. 1993 May. 82(5):287-92. [Medline].

  73. Weernink EE, de Boer MJ, Brutel de la Rivière A. Myocardial abscess after silent myocardial infarction. Thorac Cardiovasc Surg. 1989 Apr. 37(2):103-4. [Medline].

  74. Weinstein LW, Brusch JL. Infective Endocarditis. New York, NY: Oxford University Press; 1996. 175-7.

  75. Wickline CL, Goli VD, Buell JC. Coronary artery narrowing due to extrinsic compression by myocardial abscess. Cathet Cardiovasc Diagn. 1991 Jun. 23(2):121-3. [Medline].

  76. Wilson WR, Karchmer AW, Dajani AS. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. Available at JAMA. 1995 Dec 6. 274(21):1706-13. [Medline].

  77. Winek RR, Schwenk NM, Edwards WD. Fatal hemopericardium due to ruptured solitary myocardial abscess unassociated with infective endocarditis. Am J Cardiovasc Pathol. 1988. 2(3):255-7. [Medline].

  78. Witham M, Dittmer I, Williams A, et al. Myocardial abscess: an unusual complication of long-term hemodialysis line presence. Clin Nephrol. 1999 Mar. 51(3):193-4. [Medline].

  79. Zeineddin M, Stewart JA. Echocardiographic detection of non-valve-ring myocardial abscess complicating aortic valve endocarditis. Am J Med. 1988 Jul. 85(1):97-9. [Medline].

Myocardial abscess. Transesophageal echocardiogram exhibiting aortic valvular endocarditis and aortic root abscess.
Myocardial abscess. Complete heart block seen on a 12-lead electrocardiogram in a patient with myocardial abscess involving the prosthetic aortic valve ring.
Myocardial abscess. Color Doppler imaging showing flow into the aortic root abscess.
Myocardial abscess. Aortic valvular ring abscess seen by transesophageal echocardiography.
Myocardial abscess (gross).
Myocardial abscess (opened).
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