2. Definition
Infective endocarditis (IE) is defined as an
infection of the endocardial surface of the
heart, which may include one or more
heart valves, the mural endocardium, or a
septal defect. Its intracardiac effects
include severe valvular insufficiency,
which may lead to intractable congestive
heart failure and myocardial abscesses. If
left untreated, IE is generally
fatal.(medscape)
3. Infective endocarditis (IE) is a
microbial infection of the
endothelial surface of the heart
or iatrogenic foreign bodies
like prosthetic valves or other
intracardiac devices
4. Types
Native valve endocarditis
(NVE), acute and subacute
Prosthetic valve endocarditis
(PVE),[10] early and late
Intravenous drug abuse
(IVDA) endocarditis
5. •Risk factors
•Structural heart disease
–Rheumatic, congenital, aging
–Prosthetic heart valves
•Injected drug use
•Invasive procedures (Intracardiac
pacemaker, ICD , AV Fistula)
•Indwelling vascular devices
•Other infection with bacteremia (e.g.
pneumonia, meningitis)
•Immunocompromised states
•History of infective endocarditis
6. Bacterial
Staphylococcus aureus followed
by Streptococci of the viridans group
and Coagulase negativ
Staphylococci are the three most
common organisms responsible for
infective endocarditis.
Other Streptococci and Enterococci ar
e also a frequent cause of infective
endocarditis.
7. Fungal and Viral
Candida albicans, a yeast, is
associated with endocarditis in IV
drug users
and immunocompromised patients.
Other fungi demonstrated to cause
endocarditis are Histoplasma
capsulatum and Aspergillus
16. Pathologic Changes
Splenic enlargement, infarction
Septic or bland pulmonary embolism
Skin
◦ Petechiae
◦ Osler nodes: diffuse infiltrate of neutrophils,
and monocytes in the dermal vessels with
immune complex deposition. Tender and
erythematous
◦ Janeway lesions: septic emboli with bacteria,
neutrophils and S/C hemorrhage and necrosis.
Blanching and non-tender. Palms and soles
17. Splinter Hemorrhages
1. Nonspecific
2. Nonblanching
3. Linear reddish-brown lesions found under the nail bed
4. Usually do NOT extend the entire length of the nail
18. Osler’s Nodes
1. More specific
2. Painful and erythematous nodules
3. Located on pulp of fingers and toes
4. More common in subacute IE
19. Janeway Lesions
1. More specific
2. Erythematous, blanching macules
3. Nonpainful
4. Located on palms and soles
23. Two major criteria,
OR
One major and three minor criteria,
OR
Five minor criteria allows a clinical
diagnosis of definite endocarditis.
24. Other tests
Electrocardiogram
◦ Conduction delays
◦ Ischemia or infarction
Chest X-ray
◦ Septic emboli in right-sided IE
◦ Valve calcification
◦ CHF
25. Antimicrobial Therapy
Blood culture become sterile within 2 days
Fever resolves in 4 to 7 days
If fever persists despite 7 days of antibiotics
evaluate for paravalvular or extracardiac
abscess
Combination therapy most important for
◦ Shorter course regimens
◦ Enterococcal endocarditis
◦ Prosthetic valve infections
