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Internal Medicine

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Which of the following is the most likely indication of extension of a mycotic aneurysm of the sinus of Valsava (i.e., interventricular septal abscess development) in a patient with native valve S. aureus aortic valve endocarditis?

Mazen Kherallah


These EKGs show the following patterns:

A) A-V Block

B) Atrial Fibrillation

C) Ventricular Fibrillation

D) Sinus tachycardia

When the infectious process of endocarditis spreads beyond the valve leaflets, mycotic aneurysm of the sinus of Valsalva may form, which can rupture into the interventricular septum and injure the AV node, leading to complete heart block.

Although mycotic aneurysms of the sinus of Valsalva can involve other coronary cusps, rupture into the septum most often results from aneurysms in the noncoronary cusp.

Transesophageal echocardiogram is the most reliable imaging technique to detect aneurysms of the sinus of Valsalva. Surgical repair of a ruptured mycotic aneurysm, usually with aortic valve replacement, can be lifesaving.

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