![]() Transthoracic echocardiography demonstrated aortic valve vegetation with moderately severe aortic regurgitation, severe pulmonary hypertension, and an oval, large mobile density on the left-ventricular side of aortic valve measuring 1.3 x 0.7 cm consistent with endocarditis, as seen in Figures 1- -3. The basic metabolic panel showed an elevation of BUN (blood urea nitrogen) and creatinine, but that is expected given that the patient has an end-stage renal disease.Īn EKG showed sinus tachycardia with premature atrial complexes, a right bundle branch block (RBBB), and left anterior fascicular block. Thyroid function tests and complete blood count were within normal limits, except for white blood count, which was 10.6 × 10 9/L. The normal reference range of troponin is 2.420 ng/mL > 2.570 ng/mL > 1.3 ng/mL). His home medications (amlodipine, atorvastatin, isosorbide mononitrate, aspirin, pantoprazole, metoprolol, and mirtazapine) were resumed. He was empirically started on vancomycin and piperacillin/tazobactam for possible sepsis with unknown sources and was admitted to the intensive care unit. Extremities did not show discoloration of nails or rash on the palms or soles of the feet. The chest examination was normal the abdomen was soft, non-tender, non-distended, and had positive bowel sounds. He had regular tachycardic rhythm on palpation, a 4/6 diastolic decrescendo murmur best heard in the left third intercostal space, no jugular venous distention, and no pitting edema. The patient was alert and oriented to person and place but not time. Patients with atrial flutter with 2:1 or higher degree AV block may have received drugs with local anesthetic with or without anticholinergic effect, such as quinidine, procainamide, disopyramide, and flecainide, slowing the atrial rate and allowing 1:1 ventricular conduction . We present a case of 1:1 conduction of atrial flutter in a hemodynamically unstable patient with aortic valve endocarditis, recent septic embolic stroke, and no history of antiarrhythmic drug therapy.Ī 65-year-old man with hypertension, heart failure with preserved ejection fraction, end-stage renal disease, and Parkinson’s disease was admitted to our hospital for fever, altered mental status, and syncope, which began while the patient was getting dialyzed. On arrival, the patient was tachycardic and hypotensive. Atrial flutter with 1:1 atrioventricular (AV) conduction has classically been described in the setting of class 1A or 1C antiarrhythmic drug therapy . They are usually seen in patients with accessory pathways . Atrial tachyarrhythmias with 1:1 conduction are not common . It is rare that endocarditis and atrial fibrillation are found in the same patient . ![]() The incidence of typical atrial flutter increases with age, comorbidities, and any disease process that results in secondary atrial dilation . Atrial flutter is a rapid, regular atrial tachyarrhythmia that occurs most commonly in patients with underlying structural heart disease . ![]()
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