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Challenges in Clinical Electrocardiography
May 13, 2013

Significance of First-Degree Atrioventricular Block in Acute Endocarditis—Diagnosis

Author Affiliations
 

SECTION EDITORS: JEFFREY TABAS, MD; PAUL D. VAROSY, MD; GREGORY M. MARCUS, MD; NORA GOLDSCHLAGER, MD

JAMA Intern Med. 2013;173(9):726. doi:10.1001/jamainternmed.2013.3334b

Additional blood cultures were obtained, and the patient was started on therapy with intravenous vancomycin and gentamicin sulfate. The Infectious Disease and Cardiology Services were consulted for possible bioprosthetic valve infective endocarditis.

Transesophageal echocardiography revealed a ground-glass area and localized thickening between the aortic annulus and the proximal interventricular septum.

The patient remained hemodynamically stable. He was, however, persistently febrile, running low-grade temperatures while on the floor. Blood cultures grew pansensitive Streptococcus oralis, and intravenous antibiotics were deescalated to penicillin G potassium, 4 million units, every 4 hours. Results of follow-up blood cultures were negative.

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