11 December 2023
: Case report 
The Silent Threat: Bartonella quintana Endocarditis Unveiling Heart Failure and Severe Pulmonary Hypertension
Challenging differential diagnosis, Rare coexistence of disease or pathology
Daniel Boctor
1ABCDEF*, Brian Bakke1ABCDEF, John S. Chorba12ABCDEF
DOI: 10.12659/AJCR.942160
Am J Case Rep 2023; 24:e942160
Table 2. Summary of the risks and benefits of early surgery in our case.
| Risks of early surgery | Benefits of early surgery |
|---|---|
| Anticoagulation peri- or intraoperatively in the presence of known intracranial hemorrhage | Definitive treatment of the underlying cause of severe heart failure |
| Perioperative fluid shifts risking worsening of decompensated heart failure and/or pulmonary hypertension | Source control for bacteremia and prevention of further embolic strokes originating from the vegetations |
| Positive pressure ventilation in the setting of known pulmonary hypertension and right heart strain | Treatment of the cause of severe pulmonary hypertension and prevention of further remodeling |
| Acute right ventricular failure, arrythmia or cardiogenic shock | Prevention of vegetation progression, reducing risk of penetrating vegetations, heart block, or abscess formation |