Endocarditis Summary Who? Infectious: • Pre-existing valvular disease • Prosthetic valve • Congenital heart disease • IV substance use • IV catheter • Recent dental procedure • Cardiac implantable electronic devices (CIED) Non-Infectious (NTBE): • Malignancy (Marantic, verrucous) • Lung, Pancreas, Gastric & Ovarian CA • Involves aortic and mitral regurgitation • Autoimmune (SLE Libman Sacks) • Atrial myxoma • Hypercoagulable (APLAS) Microbiology: Blood cultures are positive in 90% of IE cases Culture (+): Acute: • S. Aureus • S. Epidermidis • S. Pyogenes • Enterococci Subacute: • S. Viridans (Sanguinis, Mitis, Oralis, Mutans) • S. Bovis, S. gallolyticus • HACEK, H. Parainfluenza • H. Influenza Prosthetic Valve Endocarditis: • Staphylococcus aureus • Coagulase-negative staphylococci Culture (-): • Bartonella • Brucella • Coxiella Burnetii • Streptobacillus Moniliformis • Tropheryma Whipplei • Aspergillus • Cryptococcus, Histoplasma What? Generalized: • Chills, night sweats, fever • Malaise, fatigue, weight loss • Myalgias Cardiac: • New cardiac murmur • Valvular insufficiency • New-onset Heart Failure • Dyspnea Vascular: • Systemic emboli: Cerebral > Splenic, pulmonary • Janeway lesions • Mycotic aneurysm • Splinter hemorrhages • Petechiae Immunologic: • Osler nodes • Roth’s spots • Glomerulonephritis Septic Emboli Cause Injury By: • Early embolic/ischemic insult due to vascular occlusion that may lead to infarction • Infectious insult that leads to inflammation and possible abscess formation • Other vegetations can also embolize: Marantic (NTBE) Differential Diagnosis: • Rheumatic valvular disease • Degenerative valvular disease • Vasculitis • Nonbacterial thrombotic endocarditis • Fibroelastoma • Lambl’s excrescences • Paradoxical emboli via ASD • Metastatic disease and tumor embolism Endocarditis Diagnosis? • Blood cultures • 2D Echo TTE • TTE nondiagnostic + ↑ Suspicion -> TEE • Duke Criteria • ↑ ESR, CRP • EKG: Conduction abnormalities (suggests perivalvular abscess) • Leukocytosis, anemia, and hematuria, + RF Endocarditis Rx? • IV Antibiotics • Surgery • Marantic: • Treat underlying cause + Systemic anticoagulation Pearls? • Left sided > Right sided • IV Substance use: R > L Tricuspid • Marantic: Emboli > Regurgitation • Colon CA: S. Bovis, gallolyticus, clostridium septicum • S. Viridans Surgery: • Valvular dysfunction -> symptomatic heart failure • Left sided IE: heart block, annular or aortic abscess, or destructive lesion • Complications: Abscess, destructive penetrating lesions, heart block • Persistent bacteremia/fevers > than 5 to 7 days after onset of appropriate antimicrobial therapy • >10-mm left sided vegetations to prevent emboli • S. aureus prosthetic valve endocarditis #Endocarditis #diagnosis #management #cardiology
