Utilização da Ultrassonografia Point-of-Care no Diagnóstico Precoce de Endocardite Infecciosa com Manifestações Atípicas: Relato de Caso

Abstract

Bacterial endocarditis involves the involvement of the endocardium and cardiac valves, presenting with a variable clinical spectrum and morbidity and mortality rates. Early diagnosis and initiation of appropriate therapy are crucial for prognosis. A 67-year-old female patient presented to the emergency department with sudden pain in the right lower limb associated with dyspnea. Initial evaluation revealed acute arterial occlusion of the right lower limb and sepsis of pulmonary origin. She was referred to the operating room for embolectomy under general anesthesia. Intraoperatively, she developed refractory hemodynamic instability despite high-dose vasopressor support. Empirical antibiotic therapy with piperacillin/tazobactam and intravenous vasopressin (IV) was initiated. In the immediate postoperative period, bedside transthoracic echocardiography (POCUS) identified an image suggestive of vegetation on the mitral valve, later confirmed by transesophageal echocardiography (TEE), which also revealed valvular perforation. After hemodynamic stabilization in the intensive care unit (ICU), cardiac surgery was indicated, and mitral valve replacement was performed. This case report illustrates a case of infectious endocarditis, highlighting the importance and usefulness of POCUS in the early detection of cardiac involvement in unstable patients.