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Infective endocarditis
     Benjamin Smeeton
Disease framework

Definition
Epidemiology
Pathophysiology
Clinical features
Investigations
Treatment
Definition
Infective endocarditis is an infection of the interior
surface of the heart.
It most commonly occurs on valvular surfaces.
Epidemiology
Annual incidence in the UK is 6-7 per 100,000.
It is more common in developing countries.
Without treatment, mortality approaches 100%
and even with treatment there is significant morbidity
and mortality.
Pathophysiology
Normally due to two factors:
    Microorganisms in the bloodstream
    Abnormal cardiac epithelium (facilitating their
    adherence / growth)
Pathogenesis
Bacteria are delivered to the heart during an
episode of bacteraemia.
    E.g. tooth brushing, post-surgery.
The organisms adhere to, and invade, the valve.
    Endocardium is very resistant to infection.
    Therefore, either there is an abnormality of
    the endocardium or the organisms are highly
    pathogenic.
Pathogenesis
Multiplication of the bacteria.
    As the bacteria replicate, they become
    tangled within layers of platelets and fibrin.
    These protect them from host defences.
Bulky masses called vegetations form.
    These destroy the underlying valve.
    Due to valvular softening caused by release
    of enzymes from activated neutrophils.
Pathogenesis


 Chordae
 tendinae                     Vegetation




Mitral valve
Clinical features
General:
    Malaise
    Pyrexia
    Haematuria (70%)
    Splenomegaly (40%)
    Arthralgia (25%)
    Clubbing (10%)
Clinical features
Skin lesions (lol derm):
     Osler’s nodes (painful, red, raised lesions
     found on the hands and feet)
     Splinter haemorrhages
     Janeway lesions (non-tender, haemorrhagic
     macular or nodular lesions on the palms or
     soles)
     Petechiae
Clinical features
Cardiac:
    Murmurs
    Cardiac failure
Investigations
Bloods:
     Blood culture
     ↑ESR, ↑CRP
     ↓Hb, ↑WBC
Urine:
     Dip stick + microscopy
Investigations
Echocardiography:
    Only rarely makes a diagnosis
    Assesses degree of valvular damage
Treatment
Antibiotic therapy
    Based on blood culture
    Usually intravenous, usually in combination
    4-6 weeks
Surgery (some cases)
    Remove and replace infected valve

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Infective Endocarditis

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