Infective endocarditis
Overview <ul><li>Infection of the endocardium </li></ul><ul><li>Incidence :1/1000 hospital addmisions </li></ul><ul><li>Ri...
Clinical presentation <ul><li>Acute with toxicity metastatic infection and progress over days to weeks .Subacute with prog...
<ul><li>Systemic embolisation 25 -50 % depends on the respective organs </li></ul>
Complications of IE <ul><li>Heart failure (60%) </li></ul><ul><li>Abscesses (30%) </li></ul><ul><li>Embolism (30%) </li></...
Etiology <ul><li>70-75 % have valvular abnormalities </li></ul><ul><li>Source of infection cannot always be identified </l...
Infective Endocarditis: a changing disease <ul><li>new high-risk subgroups </li></ul><ul><li>IVDA </li></ul><ul><li>elderl...
Native valve endocarditis <ul><li>Step.(60%),S.aures(25 %),Strep.Bovis( GI cansers),Enterococcus,HACEK(3%) </li></ul><ul><...
Prothetic valve endocarditis <ul><li>10-20 % of all cases </li></ul><ul><li>Risk highest in the first 6/12 </li></ul><ul><...
PPM endocarditis <ul><li>0.2-7 % ,mainly staph. </li></ul>
CS negative endocarditis <ul><li>10 % </li></ul><ul><li>Usually due to prior antibiotic therapy </li></ul><ul><li>Also fas...
Pathophysiology <ul><li>Non bacterial thrombotic endocarditis then with bacteraemia becomes septic  </li></ul><ul><li>Impa...
Labs <ul><li>Basic- mainly an acute inflamatory response </li></ul><ul><li>Blood C/S </li></ul><ul><li>Histology and C/S o...
Imaging  <ul><li>TTE  </li></ul><ul><li>TEE </li></ul><ul><li>CT brain scan </li></ul><ul><li>angiogram </li></ul>
Aortic Valve Brucella Endocarditis
Aortic Valve Brucella Endocarditis
Treatment <ul><li>Multidisciplinary </li></ul><ul><li>Patient and organism specific RX needed </li></ul>
Fungal endocarditis <ul><li>Use ampho B and flucytosine ( toxic to B. marrow and kidneys </li></ul><ul><li>Almost always n...
New guidelines 2009: timing of surgery
Vikram– JAMA 2003 ; 290 : 3207 <ul><li>513 patients with complicated IE ,  230 (40%) surgical therapy </li></ul><ul><li>6 ...
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Infective Endocarditis

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Infective Endocarditis

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Infective Endocarditis

  1. 1. Infective endocarditis
  2. 2. Overview <ul><li>Infection of the endocardium </li></ul><ul><li>Incidence :1/1000 hospital addmisions </li></ul><ul><li>Risks :Structural heart disease,immunosupression,PPMs,prologed cardiac surgery,redos,catheter based infections,sternal wound infection. </li></ul><ul><li>Mortality still 20 % </li></ul>
  3. 3. Clinical presentation <ul><li>Acute with toxicity metastatic infection and progress over days to weeks .Subacute with progression over weeks to months with less toxicity and metastatic infection. </li></ul><ul><li>Fever and new murmur(85 %) </li></ul><ul><li>CHF 55%( more in AV 75 %) </li></ul><ul><li>Neurological (embolic 20 %),encephalopathy10 %,myctic aneurysm 5 % </li></ul><ul><li>Petechia 20-40%,splinter haemmg.10-30 %,Osler nodes 10-25 %,Janeway lesions 5 % </li></ul><ul><li>Clubbing 10-20 %,splenomegaly 30-50 %,Roth spots<5 % </li></ul>
  4. 4. <ul><li>Systemic embolisation 25 -50 % depends on the respective organs </li></ul>
  5. 5. Complications of IE <ul><li>Heart failure (60%) </li></ul><ul><li>Abscesses (30%) </li></ul><ul><li>Embolism (30%) </li></ul><ul><li>Mortality (1O-20%) </li></ul>
  6. 6. Etiology <ul><li>70-75 % have valvular abnormalities </li></ul><ul><li>Source of infection cannot always be identified </li></ul>
  7. 7. Infective Endocarditis: a changing disease <ul><li>new high-risk subgroups </li></ul><ul><li>IVDA </li></ul><ul><li>elderly </li></ul><ul><li>intracardiac devices </li></ul><ul><li>nosocomial diseases </li></ul><ul><li>more difficult to prevent </li></ul><ul><li>more difficult to treat </li></ul>
  8. 8. Native valve endocarditis <ul><li>Step.(60%),S.aures(25 %),Strep.Bovis( GI cansers),Enterococcus,HACEK(3%) </li></ul><ul><li>Drug abusers ,usually S.aureus 60 %,less severe disease ,usualyy TV </li></ul><ul><li>Pseudomonas endocarditis is usually destructive and needs surgery. </li></ul><ul><li>Strep pneumoniae ,1-3 % and in the setting of alcaholism </li></ul><ul><li>Congenital lesions:commoly Bicuspid AV,PDA,VSD,Coarct. and TOF </li></ul>
  9. 9. Prothetic valve endocarditis <ul><li>10-20 % of all cases </li></ul><ul><li>Risk highest in the first 6/12 </li></ul><ul><li>Similar incidence in mechanical and bioprothetic </li></ul><ul><li>Equal in AV and MV </li></ul><ul><li>Less 2/12 post op is early,usualyy coagulase –ve staph.and S.aureus </li></ul><ul><li>Late has similar organisms to native IE,but there is 10-15 % fungal endocarditis. </li></ul>
  10. 10. PPM endocarditis <ul><li>0.2-7 % ,mainly staph. </li></ul>
  11. 11. CS negative endocarditis <ul><li>10 % </li></ul><ul><li>Usually due to prior antibiotic therapy </li></ul><ul><li>Also fastiduous organisms HACEK,Legionella,Coxiella,Bartonella,Brucella </li></ul><ul><li>Non bacterial endocarditis </li></ul>
  12. 12. Pathophysiology <ul><li>Non bacterial thrombotic endocarditis then with bacteraemia becomes septic </li></ul><ul><li>Impairement of valve function </li></ul><ul><li>Conduction defects </li></ul><ul><li>emboli </li></ul>
  13. 13. Labs <ul><li>Basic- mainly an acute inflamatory response </li></ul><ul><li>Blood C/S </li></ul><ul><li>Histology and C/S of resected specimens </li></ul><ul><li>Urinalysis </li></ul><ul><li>ECG </li></ul><ul><li>CXR </li></ul>
  14. 14. Imaging <ul><li>TTE </li></ul><ul><li>TEE </li></ul><ul><li>CT brain scan </li></ul><ul><li>angiogram </li></ul>
  15. 15. Aortic Valve Brucella Endocarditis
  16. 16. Aortic Valve Brucella Endocarditis
  17. 17. Treatment <ul><li>Multidisciplinary </li></ul><ul><li>Patient and organism specific RX needed </li></ul>
  18. 18. Fungal endocarditis <ul><li>Use ampho B and flucytosine ( toxic to B. marrow and kidneys </li></ul><ul><li>Almost always needs surgery . </li></ul><ul><li>Long term oral prophylaxis is often given to prevent relapse </li></ul>
  19. 19. New guidelines 2009: timing of surgery
  20. 20. Vikram– JAMA 2003 ; 290 : 3207 <ul><li>513 patients with complicated IE , 230 (40%) surgical therapy </li></ul><ul><li>6 month mortality </li></ul>Impact of surgery on mortality
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