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Infective Endocarditis 高雄醫學大學附設醫院 心臟內科
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],the vegetation
 
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis ,[object Object],[object Object],[object Object]
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis Frequency of preexisting cardiac lesion in Patients with IE   Age (%) Lesion Under 2 years 2-15 years 15-50 years >50 years IVDU adults No known heart disease 50-70 10-15 10-20 10 50-60 Congenital heart disease 30-50 70-80 25-35 15-25 10 Rheumatic heart disease Rare 10 10-15 10-15 10 Degenerative heart disease 0 0 Rare 10-20 Rare Previous cardiac surgery 5 10-15 10-20 10-20 10-20 Previous endocarditis Rare 5 5-10 5-10 10-20
Infective Endocarditis
Organisms Causing Infective Endocarditis
Infective Endocarditis
Infective Endocarditis
IE Clinical Manifestations   Systemic Manifestation
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis ,[object Object],Endothelial damage Platelet-fibrin thrombi Microorganism adherence
Infective Endocarditis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Venturi Effect Platelet-fibrin thrombi
Venturi Effect
Conversion of NBTE to IE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classical Peripheral Manifestations ,[object Object],[object Object],[object Object]
Janeway Lesions
Splinter Hemorrhage
Osler’s Nodes
Subconjunctival Hemorrhages
Roth’s Spots
Clinical Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Goals of Therapy ,[object Object],[object Object]
Antibiotic Therapy ,[object Object],[object Object],[object Object]
Antibiotic Therapy ,[object Object],[object Object],[object Object],[object Object]
Antibiotic Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective Endocarditis - Principles of Therapy
Microbiologic Cure Rate for Endocarditis Virridan streptococci, group A strep 98 98 Enterococcus 90 >90 S. aureus (young IVDU) 90 >90 S. aureus (elderly patients with underlying disease 50 70 Gram negative aerobic bacilli 40 65 Native Valve Endocarditis Antimicrobial therapy alone Antimicrobial therapy plus Surgery Fungus <5 50
Microbiologic Cure Rate for Endocarditis Prosthetic valve endocarditis Antimicrobial therapy alone Antimicrobial therapy plus Surgery   Early PVE Late PVE Early PVE Late PVE Virridan streptococci, group A strep NA 80 NA 90 Enterococcus NA 60 NA 75 S. aureus 25 40 50 60 Coagulase negative staphylococcus 20 40 60 70 Gram negative aerobic bacilli <10 20 40 50 Fungus <1 <1 30 40
Surgical Treatment of Intra-Cardiac Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical Treatment of Intra-Cardiac Complications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical Treatment of Intra-Cardiac Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention ,[object Object],[object Object],[object Object],[object Object]
Prevention – the procedure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention – the underlying lesion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lesions at highest risk
Prevention – the underlying lesion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
This wallet card is to be given to patients by their physician. Healthcare professionals, please see back of card for reference to the complete statement.  Name: ____________________________________________  needs protection from  BACTERIAL ENDOCARDITIS   because of an existing  HEART CONDITION   Diagnosis: __________________________________________  Prescribed by: _______________________________________ Date: ______________________________________________
Chemoprophylaxis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary ,[object Object]
Case presentation ,[object Object]
Case presentation ,[object Object],[object Object]

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Infective endocarditis

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  • 16. Infective Endocarditis Frequency of preexisting cardiac lesion in Patients with IE   Age (%) Lesion Under 2 years 2-15 years 15-50 years >50 years IVDU adults No known heart disease 50-70 10-15 10-20 10 50-60 Congenital heart disease 30-50 70-80 25-35 15-25 10 Rheumatic heart disease Rare 10 10-15 10-15 10 Degenerative heart disease 0 0 Rare 10-20 Rare Previous cardiac surgery 5 10-15 10-20 10-20 10-20 Previous endocarditis Rare 5 5-10 5-10 10-20
  • 21. IE Clinical Manifestations Systemic Manifestation
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  • 45. Infective Endocarditis - Principles of Therapy
  • 46. Microbiologic Cure Rate for Endocarditis Virridan streptococci, group A strep 98 98 Enterococcus 90 >90 S. aureus (young IVDU) 90 >90 S. aureus (elderly patients with underlying disease 50 70 Gram negative aerobic bacilli 40 65 Native Valve Endocarditis Antimicrobial therapy alone Antimicrobial therapy plus Surgery Fungus <5 50
  • 47. Microbiologic Cure Rate for Endocarditis Prosthetic valve endocarditis Antimicrobial therapy alone Antimicrobial therapy plus Surgery   Early PVE Late PVE Early PVE Late PVE Virridan streptococci, group A strep NA 80 NA 90 Enterococcus NA 60 NA 75 S. aureus 25 40 50 60 Coagulase negative staphylococcus 20 40 60 70 Gram negative aerobic bacilli <10 20 40 50 Fungus <1 <1 30 40
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  • 49.
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  • 55. This wallet card is to be given to patients by their physician. Healthcare professionals, please see back of card for reference to the complete statement. Name: ____________________________________________ needs protection from BACTERIAL ENDOCARDITIS because of an existing HEART CONDITION Diagnosis: __________________________________________ Prescribed by: _______________________________________ Date: ______________________________________________
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  • 60.