Cacciapuoti Fulvio, Crispo Salvatore, Capone Valentina, Tarquinio Luca Gaetano, Gottilla Rossella, Caso Ilaria, Pezzullo Enrica, Materazzi Crescenzo, Mauro Ciro
Division of Cardiology, "A. Cardarelli" Hospital, Naples, Italy.
Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
J Cardiovasc Echogr. 2025 Jan-Mar;35(1):61-68. doi: 10.4103/jcecho.jcecho_77_24. Epub 2025 Apr 30.
Infective endocarditis (IE) is a potentially life-threatening condition characterized by infection of the heart valves or endocardial surface, leading to significant morbidity and mortality. This case series explores four unusual presentations of IE, highlighting the diverse etiologies and complex multisystem complications that can arise from this condition. The clinical manifestations of IE can vary widely, ranging from systemic embolization to acute heart failure, reflecting the varied spectrum of pathogens involved and the patient's underlying health status. Key risk factors include preexisting valvular heart disease, intracardiac devices, intravenous drug use, and immunocompromised states. Prompt and accurate diagnosis is crucial for effective management, with echocardiography serving as the gold standard imaging modality and playing a key role as the first-line tool. Both transthoracic and transesophageal echocardiography are invaluable in identifying vegetations, evaluating valve function, and detecting potential complications such as abscesses, valve perforation, and intracardiac fistulas. The high sensitivity and specificity of echocardiography allow for early detection, even in cases with subtle or atypical presentations, ensuring that timely medical or surgical interventions are initiated. In addition, echocardiography is essential in monitoring treatment response, guiding clinical decisions, and determining the need for surgical valve replacement when severe damage or persistent infection is evident. This series emphasizes the importance of a multidisciplinary approach to treatment, which may include both medical and surgical interventions, tailored to the patient's specific clinical scenario. A heightened awareness of atypical presentations and the need for timely intervention are critical for improving patient outcomes, particularly in high-risk populations.
感染性心内膜炎（IE）是一种潜在的危及生命的疾病，其特征是心脏瓣膜或心内膜表面感染，可导致严重的发病率和死亡率。本病例系列探讨了IE的四种不寻常表现，突出了这种疾病可能出现的多种病因和复杂的多系统并发症。IE的临床表现差异很大，从全身栓塞到急性心力衰竭不等，反映了所涉及病原体的不同范围以及患者的基础健康状况。关键危险因素包括既往存在的瓣膜性心脏病、心内装置、静脉药物使用和免疫功能低下状态。及时准确的诊断对于有效治疗至关重要，超声心动图是金标准成像方式，作为一线工具发挥着关键作用。经胸和经食管超声心动图在识别赘生物、评估瓣膜功能以及检测潜在并发症（如脓肿、瓣膜穿孔和心内瘘）方面都非常宝贵。超声心动图的高敏感性和特异性能够实现早期检测，即使在表现细微或不典型的病例中也是如此，确保及时启动药物或手术干预。此外，超声心动图对于监测治疗反应、指导临床决策以及在明显出现严重损害或持续感染时确定是否需要进行手术瓣膜置换至关重要。本系列强调了多学科治疗方法的重要性，这可能包括根据患者具体临床情况量身定制的药物和手术干预。提高对非典型表现的认识以及及时干预的必要性对于改善患者预后至关重要；，尤其是在高危人群中。
