PULMONARY VALVE ENDOCARDITIS AND ATRIAL-FIBRILLATION

A 61-year-old man became ill with a fever of 39.4-degrees-C, decreased exercise tolerance and headache as well as chest pain. Physical exami nation 3 weeks after the onset of symptoms merely revealed irregular h eart rate at 100 beats/min. Erythrocyte sedimentation rate was increas ed (30/61 mm), as were serum bilirubin, lactate dehydrogenase, alkalin e phosphatase, gamma-GT and C-reactive protein. The ECG showed atrial fibrillation with a rapid and irregular ventricular rate, as well as v entricular extrasystoles (Lown type IIIA), there were no abnormal find ings on either the chest radiography or transthoracic echocardiography . Antiarrhythmic treatment brought about atrial flutter with 4:1 a-v c onduction. Transoesophageal echocardiography now revealed vegetation o n the pulmonary valve and microthrombi in the left atrial appendage. T en days after starting intravenous penicillin G (10 mega units four ti mes daily), gentamycin (60 mg three times daily) and heparin (30,000 u nits over 24 h) sinus rhythm was restored, the vegetation had got smal ler and no thrombi were demonstrated. After 27 days antibiotic treatme nt was changed to oral penicillin V. After 4 weeks the patient was dis charged symptom-free.