Endocarditis is an infection of the inner lining of the heart that often involves heart valves. It is classified based on duration, causative microorganism, type of infected valve, and source of infection. Common causes are streptococci and staphylococci bacteria entering the bloodstream from areas like the mouth or through medical procedures. Risk factors include congenital heart defects, artificial valves, rheumatic heart disease, and IV drug use. Symptoms can include fever, heart murmurs, embolic events, and immunological responses. Diagnosis involves blood cultures, echocardiography, and applying the Duke criteria. Treatment consists of long-term antibiotic therapy and may require valve surgery.

1. Dr Amera Alkaisi
PhD Oral and Maxillofacial Surgery . USM . Malaysia

2. Endocarditis
Is an infection of the inner lining of the
heart (endocardium).The infection usually
involves one or more heart valves which
are part of the endocardium

3. Classification
Clinically divided according to its duration
1. Acute bacterial endocarditis
 Affect normal valves
 Occur over days or weeks
 Staphylococcus aureus
 High virulence

4. 2. Subacute bacterial endocarditis
 Often affect damaged valves
 Caused by streptococci of low virulence
 Mild to moderate illness which progresses
slowly over weeks and months
• Has low propensity to hematogenously seed
extracardiac sites.

5. New classification that is based on
 The causative microorganism
 The type of valve that is infected
 Native valve endocarditis [NVE]
 Prosthetic valve endocarditis [PVE]
 Source of infection
 Community-acquired
Hospital-acquired
 whether the patient is an intravenous drug
user (IVDU)

7. Causes
Many microorganisms can cause infective endocarditis
 Streptococci viridans Alpha-hemolytic streptococci,
Present in the mouth are the most frequently isolated
micro-organisms
 Enterococcus
Enter the blood stream as a consequence of abnormalities
in the gastrointestinal or genitourinary tracts

8.  Staphylococcus aureus
They can enter the blood stream through procedures
that cause break in the integrity of skin like surgery
 Fungal and Viral
Fungi are seen less frequently.
Candida albicans,
 yeast,
Associated with endocarditis in IV drug users.

9. Risk factors
 Congenital heart defects
Artificial heart valves
History of endocarditis(Chronic rheumatic
heart disease)
History of intravenous (IV) illegal drug use,
cause contamination

11. The organism may enter the bloodstream through:
• Everyday oral activities
 Brushing the teeth
Chewing food can especially if the teeth and gums aren't
healthy
 An infection or other medical condition
Skin sore
Gum disease
Intestinal disorder such as inflammatory bowel disease
 Certain dental procedures (Gingivectomy)

12. PATHOPHYSIOLOGY

16. Signs and symptoms
•Fever and chills
•A new or changed heart murmur heart sounds made by
blood rushing through the heart
• Immunologic responses

21.  Neurological Sgns
 Embolic stroke
 Intracerebral hemorrhage
Multiple micro abscesses

22. Other signs of IE may include the following
•Fatigue
• Paleness
•Night sweats
•Shortness of breath
•Persistent cough
•Swelling in the feet, legs or abdomen
• Unexplained weight loss

23. •Hematuria (Blood in in urine)
•Splenomegaly
•Clubbing of the digits
•Aching joints and muscles
•Paralysis, hemiparesis, aphasia
•Conjunctival hemorrhage
•Cardiac arrhythmia
•Chest pain

24. Investigations
 Blood cultures
Three separate sets of blood cultures from different
sites obtained over a 24-hour period
 Echocardiography
As soon as possible (ideally within 24 hours)
Transthoracic echocardiogram
 Transesophageal

25. Vegetation (Arrow )on the tricuspid valve by echocardiography.

28. Diagnostic criteria
Duke criteria
Collection of major and minor criteria used to establish a
diagnosis of infective endocarditis (Established in 1994 by
the Duke Endocarditis Service)

29. The diagnosis according to this criteria could be
Definite, possible, or rejected
One of these pathological criteria
 Histology or culture of a cardiac vegetation,
an embolized vegetation, or intracardiac abscess
from the heart finds microorganisms
 Active endocarditis

30. • One of these combinations of clinical criteria
 2 major clinical criteria
 1 major and 3 minor criteria
 5 minor criteria

31. Major criteria
Positive findings on echocardiography
Positive blood culture with typical IE microorganism

32. Minor criteria
• Predisposing heart condition or IV drug use
• Fever >38°C
• Janeway lesions,
• conjunctival hemorrhage
•, Roth's spots
• Rheumatoid factor

35. Treatment

38. Surgery
 Valve repair if the damage is less severe
 Replacing a damaged valve with an
artificial valve.