Over 80% of premature deaths due to cardiovascular disease occur in Sub-Saharan Africa. We have reported a case of infective endocarditis of the aortic valve in a young adult in Cameroon, complicated by severe aortic regurgitation and heart failure with an indication for cardiac surgery. The outcome was fatal.
Infective endocarditis is a deadly disease if not promptly diagnosed and adequately treated, either with antibiotics alone and/or in association with surgery [2]. The mortality rate approaches 30% at 1 year [3]. Early diagnosis of infective endocarditis requires a high index of suspicion with understanding of its risk factors, history and physical findings [2]. The clinical presentation of infective endocarditis can be acute or sub-acute. It is a disease not to be missed but the diagnosis can be challenging.
Complications are relatively common in infective endocarditis, which can be cardiac or extra cardiac. Heart failure is the most important complication of IE which has the greatest influence on the outcome. It was reported in 72% of patients with IE in a European series [1]. The occurrence of heart failure in IE is associated with high mortality [4, 5]. It represents the most common cause of death in native valve endocarditis and the most common indication of cardiac surgery for patients with infective endocarditis [1].
Early valve surgery in patients with heart failure is associated with a significant reduction in mortality compared with medical therapy alone [4]. The three main indications for early surgery in infective endocarditis are heart failure, uncontrolled infection and prevention of embolic events [6]. Cardiac surgery centers are scarce in resource constrained settings. Even when available, the high cost of cardiac surgery makes it unaffordable for many patients, especially in emergency situations.
Heart failure is usually the consequence of valvular regurgitation which may develop acutely as a result of perforation of a valve leaflet. Acute aortic regurgitation is poorly tolerated and usually rapidly progressive. Urgent surgery is indicated in this case regardless of the status of the infection. This suggests that our patient had a poor prognosis without surgery.
Our report highlights the challenges in the management of cardiovascular emergencies especially those requiring cardiac surgical modalities in resource limited settings. Our case had complications of infective endocarditis requiring cardiac surgery. However, financial constraints led to non intervention and subsequent death of the patient. Thus, advocacy for universal health coverage should be considered by stakeholders to curb premature mortality of cardiovascular diseases.