Intravenous Drug Addiction—Staphylococcal Septicemia—Pulmonary Embolism: A Triad Pathognomonic for Tricuspid Valve Endocarditis?

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Abstract
Patients (28,29 episodes) presenting the triad of i.v. narcotic drug addiction, Staphylococcus aureus septicemia and septic pulmonary embolism were examined for the presence of tricuspid valve endocarditis. In a prospective study, 12/13 patients examined by echocardiography had vegetations on the tricuspid valve, in 6 detected by M-mode, in 5 by 2-dimensional technique and in 1 by both methods. In 4 patients with tricuspid endocarditis, no significant murmurs were heard. In a retrospective study, 5/16 patients not subjected to echocardiography had no murmurs consistent with tricupsid valve endocarditis. One of these patients died. In 2/16 patients the diagnosis was verified at autopsy and in 1 at heart surgery. In both groups, altogether 11 patients never developed murmurs, despite demonstrable vegetations in 7 of them. Thus, the triad is considered to be pathognomonic for tricupsid valve endocarditis, provided that no peripheral source of emboli is present. Consequently, patients fulfilling these criteria should be treated as suffering from endocarditis. Echocardiographic examination does not seem necessary in patients with a typical clinical picture but may be helpful when chest X-rays are inconclusive or complications are suspected.