presentation on Infective Endocarditis & Noninfected vagetation, classification of IE & Noninfected vagetation.

1. Infective Endocarditis &
Noninfected vagetation
Tahir Ramzan

2. Waht is Endocarditis
• Endocarditis is an inflammation of the
inner layer of the heart, the endocardium.
It usually involves the heart valves (native
or prosthetic valves). Other structures that
may be involved include the
interventricular septum, the chordae
tendineae,

3. Infective Endocarditis
• Infective endocarditis is a form of endocarditis,
or inflammation, of the inner tissue of the heart
(such as its valves) it is characterized by
microbial invasion of heart valves or mural
endocardium-often with destruction of the
underlying cardiac tissues-and results in bulky,
friable vegetations composed of necrotic debris,
thrombus, and organisms.
• IE is classified into acute and subacute
forms, mostly on the basis of clinical
tempo and severity

4. Classification of IE
• Acute IE: -more likely due to Staphylococcus
aureus- Usually suggests a destructive
infection, causing death within days to weeks in
more than 50% of patients despite antibiotics
and surgery.
• Subacute endocarditis: is often due to
streptococci of low virulence and mild to
moderate illness which progresses slowly over
weeks and months and has low propensity to
hematogenously seed extracardiac sites

6. Pathogenesis
• IE can develop on previously normal valves,
but the presence of cardiac abnormalities
predisposes to such infections.
• Sterile platelet-fibrin deposits at sites of jet
streams caused by pre-existing cardiac
disease may also contribute in seeding of
bacteria leading to endocarditis.

7. Cont…
• Host factors :such as neutropenia,
immunodeficiency, malignancy, therapeutic
immunosuppression, diabetes mellitus, and
alcohol or intravenous drug abuse also increase
the risk of IE
• Endocarditis of previously damaged or
otherwise abnormal valves is caused most
commonly (50% to 60% of cases) by viridans
Streptococci, a relatively banal group of normal
oral flora

8. Cont…
• More rarely, gram-negative bacilli and fungi are
involved. In about 10% of cases, no organism
can be isolated from the blood ("culturenegative" endocarditis). This is attributed to
previous antibiotic therapy or difficulties in
isolating the offending agent, or because deeply
embedded organisms within the enlarging
vegetation are not released into the blood.
• Foremost among the conditions predisposing to
endocarditis is seeding of the blood with
microbes

9. Clinical Features
• Fever is the most consistent sign of IE.
However, in subacute disease (particularly
in the elderly) fever may be absent
• The only manifestations may be
nonspecific fatigue, weight loss, and a
flulike syndrome. Splenomegaly is
common in subacute IE.

10. Cont..
• Murmurs are present in 90% of patients
with left-sided lesions, but these may
merely relate to the pre-existing cardiac
abnormality predisposing to IE.
• Diagnosis is largely made on the basis of
positive blood cultures, echocardiographic
findings, and other clinical and laboratory
findings.

11. Reference: "Robins Basic Pathology"

12. Non-infected Vegetations:
• Nonbacterial thrombotic endocarditis
(NBTE) is characterized by the deposition
of variably sized masses of fibrin,
platelets, and other blood components on
cardiac valves.
• In contrast to IE, the valvular lesions of
NBTE are sterile and do not contain
microorganisms. Valvular damage is not a
prerequisite for NBTE.

13. Pathogenesis
• It typically occurs in the setting of ..
• hypercoagulable states
• hyperestrogenic states.
• malignant cancers.particularly
adenocarcinomas
• Endocardial trauma ..

14. Clinical Features
• The local effect on the valve is usually
trivial, NBTE lesions can become clinically
significant by embolizing to the brain,
heart, or other organs.
• NBTE can also serve as a potential host
for bacterial colonization and thus leads to
development of IE

15. • Reference: "Robins Basic Pathology"

16. Thank You.! :)