Aortic stenosis s/p septic ARDSw ne Blood cultures...

[hoolahan, ASN, RN]

Hi. I have a pt who had a Total knee gone wrong, got infected, and became so infected, entire knee hardware had to be removed.

He was in a rehab, and developed T103, w sob. Tx to Acute care hosp, was found to have bilat pneumonia, developed into ARDS, vented x 3 mo, now has been extubated and recovering well, back in rehab, but unable to make any progress d/t no knee.

Finally going to get the knee replaced again, but ortho wanted a cardiac clearance.

Cradiologist does an echo in the office, and later tells pt he now has AS mod degree w murmur. So, now he wants TEE aND possibly a nuc stress test and maybe a cath.

Since this is a worker's comp, we are denying the cardiac testing, it will be paid by his orimary health insur, so not screwing the pt in any way. I mean, the echo says valve is also calicfied!! Isn't this a process that occurs over time? not after a month or even six months of debilitation??

My question is, have you heard of AS developing as a result of a sepsis that was NOT in the blood, ie he had negative blood cultures. How can doctor claim this is causally realted to the new AS?? I have read a lot about AS, and yes it can result from SBE and strep infec, but he had a sensitive staph infection, not any strep, and neg BC.

Any opinions??

[Going80INA55]

I would want to know if this is the guys first lap around the pool with cardiology.

Yes, calcification does take time to develop. Vegetation would be indicative of a bug.

The MD may be saying that it is "causally realted to the new AS", because of the stress on the body. Meaning the AS was already there and then with the added stress on the heart and body from the knee, then pneumonia allowed it to present itself.

[c.wicks]

Was this pt positive for a staph infection? Staphylococcus aureus is often assosiated with pericarditis. S.aureus commonly resides in oral mucus membranes and is an opportunistic infection which may become problematic following burns, trauma or surgical procedures. Aortic stenosis is most often preceded by a systemic infection or embrionic anomalies. Was the pt's surgery due to injury or was it r/t a systemic connective tissue disease? CT disease can be a preexisting condition leading to acute pericarditis. Atherosclerosis and degenerative calcification of the aortic valve have become the most common valvular disorder within our aging population. Other causes of valvular heart disease include viruses and fungi. Some organisms are difficult to grow in a culture, others can take several weeks, and identifying specific viruses is like opening up "A Whole Box of Pandora's".

[globalRN]

yes, atherosclerotic changes.

Also syphilis