Q: 54 year old male with End Stage Renal Disease (ESRD) and on scheduled hemodialysis (HD) is diagnosed with infective endocarditis (IE). Plan is to start a 6 weeks course of antibiotics prior to consideration for surgery. Follow-up transthoracic echocardiogram (TTE) should be performed every 2 weeks to evaluate the size of vegetation.
A) True
B) False
Answer: B
There is no need for regular constant follow-up via TTE on patients with infective endocarditis unless ineffective treatment or some complication is suspected like new murmur, embolic phenomenon, signs of congestive heart failure (CHF), AV block, new or persistent fever or evidence of persistent bacteremia. Cardiologist/CV surgeon may decide to do follow-up echo at his clinical discretion on individual basis but there is weak evidence to do frequent surveillance echo just to determine vegetation size.
Also, in patients with ESRD, removal of the AVF or graft is not indicated unless it is a constant source of infection. Many of these patients are highly 'vasculopath' and inserting new dialysis catheter may carry higher overall risk. All such decisions should be individualized.
#IE
#cardiology
#nephrology
References:
1. Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, Voigt JU, Sicari R, Cosyns B, Fox K, Aakhus S; European Association of Echocardiography. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010 Mar;11(2):202-19. doi: 10.1093/ejechocard/jeq004. PMID: 20223755.
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