Since it is very rare that
cardiac tamponade due to myocardial
rupture caused by
infective endocarditis, occurs we are reporting this case. A 62 year old man, who had underlying diseases of
pneumoconiosis and hypertensive
heart disease, visited Chikuho Rosai Hospital complaining of chest oppression and general
fatigue on Feb. 7, 1987. He was diagnosed as having
ischemic heart disease by electrocardiogram. Two days later, he suddenly had
chills and a
fever, and the laboratory data showed
leukocytosis and a positive
C-reactive protein (CRP). The echo cardiogram showed
mitral regurgitation (MR) and
aortic regurgitation (AR), but neither vegetation nor
pericardial effusion was observed. On Feb. 16, he was admitted with
shock, and he died the next day. The blood cultures grew gram-positive cocci, respectively. From the clinical symptoms, chest roentgenogram and electrocardiogram, we suspected a
cardiac tamponade. On autopsy findings, though coronary arteries were intact, the aortic valves had severe valvular adhesions, calcifications and
hypertrophies. The
rupture hole was observed in the left ventricles, which was just under the aortic valve through the pericardiac space. It seemed that he died of a
cardiac tamponade due to the outflow of blood from this hole. On histopathologic findings of the cardiac wall, gram-positive cocci and many of neutrophils were observed.