A 54-year-old patient is admitted for thermometric fever of 38°C in the previous five days and dyspnea at rest (NYHA lV) that appeared 6 hours before coming to the hospital. Examination in the emergency room was compatible with heart failure and the ECG showed complete atrioventricular block with an escape ventricular rate of 45 bpm. Signs of heart failure are refractory to medical treatment and transesophageal echocardiography shows an aortic valve with an effective regurgitant orifice of 0.5 cm2. Serial cultures are positive for Streptococcus gallolyticus. Indicate the best course of action:
The correct answer is 1, since the indications for cardiac surgery include the appearance of heart failure or new conduction disorders, and in this case it presents both.
Cardiac surgery for aortic valve replacement by mechanical prosthesis with antibiotic therapy according to antibiogram.
Antibiotic therapy according to antibiogram and implantation of intra-aortic balloon counterpulsation and transient pacemaker for up to 3 weeks, after which a permanent pacemaker will be implanted.
Implantation of transient pacemaker, antibiotic therapy according to antibiogram and percutaneous implantation of aortic valve prosthesis.
Urgent implantation of definitive pacemaker with antibiotic therapy according to antibiogram for 6 weeks.
the indications for cardiac surgery include the appearance of heart failure or new conduction disorders, and in this case it presents both.