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Acute Heart Failure - Diuretic Resistance — EECC MCQ

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HardHeart FailureAcute Heart Failure - Diuretic ResistanceEECC

A haemodynamically stable patient receiving appropriate antibiotics for aortic-valve endocarditis develops a new complete atrioventricular block. TOE shows a 14-mm peri-annular abscess without acute pulmonary oedema. Which timing strategy is most appropriate?

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Correct answer: C — Arrange urgent valve surgery during the current admission for locally uncontrolled infection

Peri-annular abscess with new atrioventricular block is locally uncontrolled infective endocarditis and requires urgent valve surgery during the current admission even in the absence of shock or pulmonary oedema. To complete the full intravenous antibiotic course before source control or to schedule elective surgery after discharge allows invasive infection to progress. Permanent pacing treats the electrical consequence but not the abscess. Transcatheter aortic implantation introduces prosthetic material into active infection and does not provide surgical debridement.

Reference: 2023 ESC Guidelines for infective endocarditis. https://academic.oup.com/eurheartj/article/44/39/3948/7243107