Tackett Madison S, Ahmed Taimoor, El-Dalati Sami A, Ahmed Taha
Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA.
Department of Infectious Disease, University of Kentucky Medical Center, Lexington, Kentucky, USA.
BMJ Case Rep. 2023 Mar 30;16(3):e254403. doi: 10.1136/bcr-2022-254403.
The incidence of infective endocarditis in pregnancy has increased as a result of the opioid epidemic. Right-sided infective endocarditis (RSIE), specifically tricuspid valve endocarditis, is more commonly linked to injection drug use. In pregnant patients, a prompt diagnosis and treatment of infective endocarditis are crucial to prevent fetal and maternal morbidity and mortality. Complications associated with infective endocarditis in pregnancy include death, preterm labour and embolic disease. RSIE is classically linked to septic pulmonary emboli; however, we report a unique case of a pregnant patient with known tricuspid valve infective endocarditis. Our patient unfortunately developed an ischaemic stroke from paradoxical brain embolisation in the setting of a previously undiagnosed patient foramen ovale. Furthermore, we demonstrate the importance of considering how normal cardiac physiological changes associated with pregnancy can impact the clinical course in patients with RSIE.
由于阿片类药物流行，妊娠期感染性心内膜炎的发病率有所上升。右侧感染性心内膜炎（RSIE），特别是三尖瓣心内膜炎，更常与注射吸毒有关。对于孕妇，及时诊断和治疗感染性心内膜炎对于预防胎儿和产妇的发病和死亡至关重要。妊娠期感染性心内膜炎相关的并发症包括死亡、早产和栓塞性疾病。RSIE 典型地与感染性肺栓塞有关；然而，我们报告了一例患有已知三尖瓣感染性心内膜炎的孕妇的独特病例。不幸的是，我们的患者在存在先前未诊断出的卵圆孔未闭的情况下，因反常脑栓塞而发生了缺血性中风。此外，我们证明了考虑与妊娠相关的正常心脏生理变化如何影响 RSIE 患者的临床病程的重要性。
