Myocardial Abscess - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Cossio and Berconsky, in 1993, had reported a case of coronary malfunctioning along with a heart attack in which a myocardial abscess was found in the examination of the body, and this was the first reported case of the myocardial abscess. A myocardial abscess refers to an infection that is suppurative and affects several heart structures, such as heart muscles or myocardium, prosthetic valves, and endocardium tissue. Parallel to other suppurative infections, myocardial abscess develops due to dissemination from a far locus- sepsis or bacteremia or direct extension of an underlying cardiovascular disease. One of the major etiological factors behind myocardial abscess is infective endocarditis. It should be noted that the diagnosis of a myocardial abscess is extremely difficult, and generally, it is found after death has occurred during post-mortem examination. The major complication of myocardial abscess is an alteration in the rhythm and beating of the heart.

What Are the Causes of Myocardial Abscess?

Myocardial abscesses have been generally thought to occur due to an underlying cardiovascular infection. Staphylococcus aureus and Escherichia coli are the two primary organisms that lead to the development of a myocardial abscess. Other main causes of myocardial abscess are persistent or transient bacteremia without any known cardiovascular source. Mentioned below are the organisms that lead to the development of myocardial abscesses, along with several causes for the same.

• Myocardial infarction.

• Prosthetic valvular infection.

• Bacteremia.

• Haemophilus and related species.

• Enterococci infections.

• Beta-hemolytic streptococci infections.

• Streptococcus pneumoniae infection.

• Injury or trauma.

• Deep wounds and burns.

• Infected pseudoaneurysms.

• Pericarditis.

• Infection during a heart transplant.

• Transplant of an infected heart.

• Sternal abscess.

• Myocarditis.

• Human immunodeficiency virus.

• Endocarditis.

• Parasitic and fungal infections

• Left ventricular aneurysm.

• Tumor.

Who Is at Risk of Developing Myocardial Abscess?

Any kind of abscess has primary foci, and several conditions place an individual at a higher risk of developing an abscess. Mentioned below are a few of the potential risk factors for myocardial abscess.

• Renal infection.

• Urinary tract infection.

• Appendix.

• Colon cancer.

• Diverticulitis.

• Cohn’s disease.

• Bone infections.

• Gastrointestinal diseases.

• Pott’s disease.

• Osteomyelitis.

• Hematogenous spread.

• Diabetes Mellitus.

• Cirrhosis.

• Malignancy.

• Remote infections.

• Glucocorticoids.

• Renal insufficiency.

• Hepatic malfunctioning.

What Are the Signs and Symptoms of Myocardial Abscess?

A myocardial abscess is a cardiovascular condition that is characterized by a suppurative infection. Thus, the signs and symptoms are vast and involve both cardiovascular manifestations and manifestations of suppurative abscesses. Mentioned below are a few of the signs and symptoms of a myocardial abscess.

• Fever.

• Chronic renal failure.

• Debility.

• Chills.

• Malaise.

• Anorexia (an eating disorder characterized by an intense fear of gaining weight).

• Weight loss.

• Myalgia (muscle pain).

• Arthralgia (joint pain).

• Abdominal distention.

• Backache.

• Confusion.

• Excessive sweating.

• Abdominal discomfort.

• Tachycardia (increased heart rate).

• Heart murmurs.

• Embolic changes.

• Clubbing (a condition where the fingertips and nails become enlarged and the angle between the nail and the finger increases).

• Cyanosis (a bluish discoloration of the skin and mucous membranes).

• Splenomegaly (abnormal enlargement of the spleen).

• Osler’s nodes (painful, raised lesions on the fingers or toes).

• Splinter hemorrhages (small lines of blood under the nails).

• Petechiae (brown or purple spots on the skin).

• Janeway lesions.

• Retinal changes.

• Roth spots.

• Wide pulse pressure.

• Aortic regurgitation.

• Fatigue.

• Septicemia.

• Drowsiness.

• Decreased level of consciousness.

• Tachypnea (rapid and shallow breathing).

• Anemia.

• Decrease in serum iron.

• Leukocytosis.

• Renal failure.

• Hematuria (blood in urine).

• Proteinuria (protein in urine).

• Acute kidney injury.

• Fleischner sign (enlargement of the pulmonary artery).

• Hampton hump.

• Watermark's sign (appearance of a crescent-shaped subpleural lucency on a chest X-ray).

• Strain on the right side of the heart.

• Tenderness of the chest.

• Polo-mint sign.

• Intraluminal filling defect.

• Takayasu arteritis.

• Churg-Strauss syndrome.

• Swelling of the walls of the vessels.

What Is the Differential Diagnosis of Myocardial Abscess?

Some of the differential diagnoses of myocardial abscess include:

• Heart transplantation.

• Mitral regurgitation.

• Heart-lung transplantation.

• Septic shock.

• Myocardial infarction.

• Infective endocarditis.

• Penetrating chest trauma.

• First-degree atrioventricular block.

• Infections following solid organ transplantation.

• FUO (fever of unknown origin).

What Are the Complications of Myocardial Abscess?

Complications of myocardial abscess include

• Death.

• Heart block.

• Acute respiratory distress syndrome.

• Congestive heart failure.

• Multiple organ failure.

• Stroke.

• Arrhythmias.

How to Diagnose Myocardial Abscess?

The exact diagnosis of a myocardial abscess is made after a deep understanding of the clinical manifestations that the patient presents with, as well as a thorough case history that includes the medical history, physical history, drug history, and family history, as well as recent hospitalization. A complete blood picture is a must in case there is a doubt of a myocardial abscess. Analysis of the urine is an additional diagnostic tool. Mentioned below are a few of the diagnostic measures to determine the presence of a myocardial abscess.

• Chest x-rays.

• Transthoracic echocardiography or TTE.

• Transesophageal echocardiography or TEE.

• 111 radionuclide scintigraphy.

• Computed tomography or CT scan.

• Magnetic resonance imaging or MRI.

• Intraoperative echocardiography.

• Electrocardiography.

• Tests to stimulate the immune system.

• Serological studies.

• Cardiac catheterization.

• Coronary angiography.

• Valve surgery.

How to Treat Myocardial Abscess?

There are positive treatment options for myocardial abscess. The correct diagnosis leads to an excellent treatment and management plan. Mentioned below are a few of the treatment modalities for myocardial abscesses.

• Intravenous antibiotic therapy.

• Empiric broad-spectrum antibiotics.

• Increased fluid intake.

• Electrolyte balance.

• Surgery.

What Is the Prognosis of Myocardial Abscess?

Patients can achieve quick recovery if diagnosed early and promptly treated. The outlook is typically unfavorable without surgical intervention.

Conclusion

A myocardial abscess is a pus-filled infection of the endocardium, myocardium, and the cardiac conduction system as a whole. Infective endocarditis is long-standing and not treated, generally leading to the development of a myocardial abscess. The major complication of myocardial abscess is an alteration in the rhythm and beating of the heart. The signs and symptoms of the patient suffering from a myocardial abscess are vast. Thus, precise and apt diagnoses are crucial to draw a successful line of treatment and management strategies. Surgical intervention remains one of the most successful treatment options for myocardial abscess, but it is recommended after all other treatment phases have failed. The patient has a positive outlook on life and the treatment of the myocardial abscess.