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Myocardial Abscess Treatment & Management

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

Medical Care

Medical treatment includes the following:

  • Antibiotics
  • Agents for stabilization of hemodynamic status

Supportive treatment includes the following:

  • Fluid and electrolyte balance
  • Nutritional support
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Surgical Care

Once the diagnosis of myocardial abscess is made, the treatment of choice is surgical in nature. Appropriate procedures include the following:

  • Open heart surgery
  • Valve replacement
  • Re-replacement of prosthetic valves
  • Abscess evacuation
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Consultations

Myocardial abscess usually develops in patients who are generally very ill, with multiorgan system involvement and unremitting infective endocarditis. The expertise of several subspecialists is needed:

  • Cardiologist
  • Cardiovascular surgeon
  • Infectious disease specialist
  • Intensive care medicine and pulmonary medicine specialists
  • Nephrologist
  • Microbiologist/pathologist
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Diet

Patients with myocardial abscess are often critically ill. Supplementation of nutritive food, either by the enteral or parenteral route, is very important.

Patients must be maintained without oral intake until a decision regarding surgical intervention has been made and surgery has been performed.

Postoperatively, gradual advancement in the diet is recommended.

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Activity

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 deep venous thrombosis (DVT) and pulmonary embolization (PE).

Gradual increase in ambulation is recommended following surgical intervention.

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

Acknowledgements

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.

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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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