Infective endocarditis is an infection of the heart valves or endocardium that is usually caused by bacteria or fungi forming clusters called vegetations. Antibiotics are the primary treatment. It can be classified as native valve, prosthetic valve, or intravenous drug abuse-related endocarditis. Native valve endocarditis commonly affects pre-existing valve damage and is caused by various organisms. Prosthetic valve endocarditis can be early or late-onset depending on time since valve placement and causing organisms differ. Symptoms vary between subacute presentations with fever and embolic phenomena, and acute presentations with rapid valve destruction and increased risk of embolism. Diagnosis involves blood cultures, echocardiography identifying

1. INFECTIVE ENDOCARDITIS
Presented by:
Cristina Joy F. Reyes

2. • Definition
Infective endocarditis (IE ) is an infection of the heart valves or the
endocardial lining of the wall
Etiological agent – most commonly bacteria but may be fungal.
Vegetation – bacterial or fungal infection of the valves form
clusters of organisms.
- can be seen by echocardiography
Antibiotics are essentially the only treatment for endocarditis.

3. Location of vegetations

4. Etiology
• Classified into three categories:
Native Valve IE
Intravenous drug abuse (IVDA) IE
Prosthetic Valve IE
• Acute IE
• Aggressive
• Rapidly destructive
• Commonly Staph. (S. aureus)
• Infecting native and normal
heart valve
• Fatal within 6 weeks (if not
treated)
• Subacute IE
• Commonly viridans
streptococci
• Often affects damaged
heart valves
• Indolent nature
Classification

5. Native Valve Endocarditis
• Native Valve Endocarditis
 Caused by any organism (but most common) viridans
streptococci, enterococci, and S. aureus
 S. aureus can attack normal valves
 Most patients will have some damage to the heart valves
• Rheumatic
• Age- related degeneration

6. Endocarditis in Intravenous Drug Abusers
• Endocarditis in Intravenous Drug
Abusers
 Caused by S. aureus (common) ,
streptococci, enterococci, gram-
negative organisms and fungi.
IV drug users have infection of the tricuspid
valve.

7. Early - onset disease
o<60 days from
placement of the
prosthetic valve
oS epidermidis and S.
aureus
oGram negatives and
fungi (common)
Late - onset disease
o>60 days from
placement of the
prosthetic valve
oStreptococci or other
organisms that are
indigenous flora
A group of gram - negative fastidious
organisms known as the HACEK groupHACEK group
1.Haemophilus
2.Actinobacillus
3.Cardiobacterium
4.Eikenella
5.Kingella
HACEK groupHACEK group are responsible for '' culture negative '' endocarditis
Prosthetic Valve Endocarditis (PVE )

8. Pathophysiology
Subacute endocarditis
The congenital or acquired abnormal valve cause flow disturbances that injure the
endocardial lining of the heart valves or wall
Area of injury becomes a focus of thrombus formation
Dental work or manipulation of either the gastrointestinal or genitourinary tracts
with endoscopes, catheters and surgical instrument can cause bacteremia
Vegetation grow, erode the valve, and may create myocardial abscesses
Fragments can break off as emboli

9. Symptoms and Signs
Subacute endocarditis
Symptoms Signs
Fever Heart murmur
Sweats *Petechiae (optic fundi,
conjunctiva, mucosal surface,
skin)
Anorexia *Subungal Splinter
hemorrhage
Malaise *Janeway lesions
Myalgias *Osler’s nodes
Arthralgias

10. Peripheral manifestations
• Petechiae : ( most common )

12. Pathophysiology
 Acute Endocarditis
Direct attack of normal valves by aggressive organisms that can destroy valves
rapidly
Abscess formation and disruption of cardiac conducting tissue
Emboli (more common) especially with S. aureus

13. Symptoms and Signs
Acute endocarditis
Symptoms Signs
*Renal manifestation
Back pain, hematuria)
*Skin pustules
Stroke, seizures or meningitis
(more common)
Arthritis
Osteomyelitis
Splenomegaly
*Retinal lesions (roth’s spot)

14. Diagnosis
No single test makes the diagnosis of endocarditis
MAJOR CRITERIA & MINOR CRITERIA
Endocarditis
Major criteria – presence of multiple positive blood
cultures &
Echocardiogram Valvular vegetations or
paravalvular abscess
History, Physical exam, Blood cultures, and
Echocardiogram
Endocarditis

15. Duke Criteria

16. THANK YOU