P1453 Unfortunate association between obstructive hypertrophic cardiomyopathy and infective endocarditis

Abstract

Abstract Bacterial endocarditis is an uncommon, but potentially severe complication of hypertrophic cardiomyopathy (prevalence < 1%). We report the case of a 27-year-old woman, with low socioeconomic status, with hypertrophic cardiomyopathy, presenting with chest pain, dyspnoea at moderate effort, fever and chills. The transthoracic and transoesophageal echocardiography showed obstructive septal hypertrophic cardiomyopathy (interventricular septum of 38 mm, systolic anterior motion of the mitral valve, maximum gradient in the left ventricular outflow tract of 80 mmHg), vegetations of 10 mm, on the atrial and ventricular mitral leaflets sides, mitral valvular abcess, severe mitral regurgitation, flail of the noncoronarian aortic cusp (with a 10 mm vegetation), severe aortic regurgitation, basal SIV vegetation, pericardial effusion. The blood cultures were positive for Streptococcus mitis. The thoracic, abdominal, pelvin CT scan confirmed the diagnosis of mitral-aortic infective endocarditis , revealing also an abcess of the aortic root and multiple embolisations (spleen and right external iliac artery). The cranial CT scan was normal. At the evaluation of the foci sites, multiple dental foci were discovered and treated by multiple extractions. The endocarditis team recommended antibiotic treatment (with ampicillin), urgent bivalvular replacement (aortic and mitral valve) and septal myectomy. The surgical procedure was denied by the patient, which was after that voluntarily discharged from the hospital. The patient died from cardiac arrest (asystole) 11 days after the initial diagnosis. A severe association between obstructive hypertrophic cardiomyopathy and infective endocarditis with multiple complications can have an initial paucisymptomatic clinical presentation. The low socioeconomic status of the patient was correlated with inadequate oral hygiene, that was a negative prognostic factor in the outcome of the patient. It is possible that the integration of oral health in our national general health programs for people with low socioeconomic status, will decrease morbidity and improve the quality of life. Abstract P1453 Figure. picture clinical case