A Barely Responsive Woman Dropped at the ED With a Note

Gregory Taylor, DO; Eric McDowell, DO

Disclosures

November 05, 2020

Discussion

Infective endocarditis is an infection of the endocardial lining of the heart that is caused by viral, fungal, or bacterial microorganisms.[1] The lesions, referred to as "vegetations," are a conglomerate of platelets, fibrin, and infecting organisms, which can lead to ulceration and perforation of the valve cusps.[2] In the United States, the incidence of infective endocarditis is estimated to be 15 cases per 100,000 population.[3] Staphylococcus aureus is the most common cause of infective endocarditis among IV drug abusers. Streptococci and Enterococci are the next most common causes; however, most cases to date have been due to staphylococci.[4]

The patient in this case had infective endocarditis that resulted in septic shock, acute respiratory distress syndrome, and disseminated intravascular coagulation. Although the list of differential diagnoses is long, numerous clinical signs are suggestive of infective endocarditis. The disease can present as acute, rapidly progressive, or subacute to chronic, with fever and nonspecific symptoms. Fever has been shown to be the most common symptom and is present in as many as 90% of cases; it is often associated with weight loss, chills, and anorexia.[5] Other symptoms may include shortness of breath, cough, night sweats, headache, and myalgias. Furthermore, cardiac murmurs are found in about 85% of patients.[5]

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