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Infective Endocarditis Causes, Types and Treatment
- 2. • A condition caused by microbial infection of-a heart valve, lining of a cardiac chamber or blood vessel. • May also be due to a congenital anomaly.
- 3. Microbiology • Most common : staphylococcus and streptococcus • Staph.aureus : acute endocarditis • Staph.epidermidis : post operative endocarditis • Enterococcus • HACEK group • Coxiella burnetti- endocarditis in Qfever • Candida, aspergillus - Immunocompromised, prosthetic valves
- 4. Pathophysiology • At the sites of pre existing endocardial damage • A previously normal heart can also be affected if highly virulent • Cardiac damage caused due to high pressure blood flow as in VSD, MR,AR • Prone in areas of endothelial damage ( high affinity of microorganisms)
- 5. • Deposition of fibrins, platelets • Formation of vegetations • May even cause obstruction or emboli • Can destroy adjacent tissues • Abscess formation • Can also lead to valve regurgitation,cusp perforation, disruption of chordae tendinae …etc
- 6. Types
- 7. Subacute endocarditis • Suspected when a patient with congenital or valvular heart disease presents with- persistent fever,unusual tiredness,nights sweats or weight loss. • Purpura and petichial hemorrhage : skin and mucous membrane • Splinter hemorrhage : fingernails, toenails
- 8. Acute endocarditis • Severe febrile illness • Prominent changing heart murmurs • Petechiae • Abcesses may be detected on echocardiography
- 9. Post-operative endocarditis • Unexplained fever in pt after heart valve surgery • Resembles acute or subacute endocarditis • High morbidity and mortality • Usually due to coagulase negative staph introduced during the perioperative period
- 12. • 2 major OR 1 major + 3 minor OR 5 minor - definite endocarditis • 1 major + 1 minor OR 3 minor- possible endocarditis
- 13. Investigations
- 14. Blood culture • To identify the causative organism and guide antibiotic therapy • 3-6 sets of blood cultures prior to therapy • Taking discrete sets at intervals of >6hrs reduces risk of misdiagnosis • Isolation of organism in more than one culture- string evidence of dx
- 15. Echocardiography • To detect and follow the progress of vegetation • To assess valve damage • To detect abcess formation
- 16. Other investigations • ECG- may show AV block- aortic root abcess formation • CXR- evidence of cardiac failure and cardiomegaly
- 17. Management • Medical-organism, prosthetic valve,penicillin allergy • Surgical
- 18. Medical management • Native valve- 4 week regimen • Prosthetic valve-6 week regimen
- 20. • Benzylpenicillin IV 2.4g 6 times daily Plus • Gentamicin 1mg/kg twice daily • 2 week regimen • Ceftriaxone 2g OD IV , if allergic to penicillin
- 21. Subacute endocarditis • Wait for culture results • Amoxicillin 2g iv 6 times daily with or without gentamicin
- 22. Acute endocarditis • Vancomycin 1 g iv twice daily Plus • Gentamicin 1mg/kg iv twice daily
- 23. Surgery • Cardiac surgery with debridement of infected material • Valve replacement
- 25. Thank you for the patient listening ❣️