title: Changing conduction abnormalities in a dialysis patient with fever.
abstract: A patient on hemodialysis with severe aortic valve disease and presumed arteriovenous fistula infection was found to have new-onset atrial fibrillation and alternating left and right bundle branch block patterns on serial electrocardiograms. These findings prompted transesophageal echocardiography, which revealed a large abscess involving the intervalvular fibrosa and the posterior cusp of the bicuspid aortic valve. Hence, basic bedside diagnostic skills remain important in the era of sophisticated imaging techniques and laboratory analyses.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Walter
authors.initials: W
authors.lastname: Coats
authors.forename: Anjli
authors.initials: A
authors.lastname: Maroo
authors.forename: Tjuan L
authors.initials: TL
authors.lastname: Overly
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
mesh_terms: D000038:Abscess / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000601:surgery; D006348:Cardiac Surgical Procedures; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D017809:Fatal Outcome; D005334:Fever / Q000382:microbiology*; D006323:Heart Arrest / Q000209:etiology; D006329:Heart Conduction System / Q000503:physiopathology*; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000382:microbiology / Q000601:surgery; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008943:Mitral Valve / Q000382:microbiology; D006435:Renal Dialysis; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis*; D013212:Staphylococcus epidermidis / Q000302:isolation & purification