Infective Endocarditis presented to cog

1. Infective Endocarditis
NICKSON MAZUBA
NWUCHAS JULY 2019

2. Definition
• Infective endocarditis is microbial infection of the
endocardial surface of the heart
• Commonly involves the valves
• Characterised by formation of vegetation that are
composed of:
– Inflammatory cells
– Fibrin
– Platelets
• May be classified as
– Acute or subacute

3. aetiology
• Staphylococci
– Commonest cause of endocarditis
– S. aureus most common organism in cases of right sided
endocarditis in IV drug users and HIV Positive Pt
– S. epidermidis common in prosthetic valves
• Streptococci
– S. viridans most common
– Enterococci occurring in elderly

4. • Other causes
– Fungi-in intravenous drug users, immunocompromised
patients
– Gram negative bacilli
– Gonococcal
– Pneumococcal
• HACEK group
– Haemophilus
– Actinobacillus
– Cardiobacterium
– Eikenella
– kingella

5. Risk factors
• Rheumatic valve disease
• Intravenous drug use
• Bicuspid valves
• Aortic stenosis
• Aortic insufficiency
• Mitral valve prolapse
• Marfan syndrome
• Previous endocarditis
• Pulmonary artery cartherization

6. Pathophysiology
• normal endothelium is resistant to infection by
most bacteria and to thrombus formation
• Infective endocarditis occurs at sites of pre-
existing endocardial damage
• Organism may directly infect the Intact
endothelium or exposed subendothelial tissue,
• These areas attract fibrin and platelet
aggregation.
• Platelet plugs further attract colonization by
micobial organisms

7. Pathophysiology cont.d
• Vegetations may grow
• Large vegetations
– may break away as emboli
– May destroy adjacent tissues
– May cause aneurysm

8. Frequency of cardiac valve
involvement
• mitral>aortic>tricuspid>pulmonary
• 30% of patients have concomitant aortic and
mitral valve involvement
• 5% of patients have simultaneous
involvement of left and right sided heart
valves

9. Clinical features
• Highly variable
• Can be acute or subacute
• Can be classed as
– Native valve endocarditis
– Prosthetic valve endocarditis
– Endocarditis in intravenous drug users

10. Features continued
• Fever
– Generally present but may be absent in elderly or
immunosuppressed
– In subacute endocarditis, fever is typically low-
grade and rarely exceeds 39.4C
• Cardiac Manifestations
– Heart murmur
– CCF in 30 to 40%

11. • Musculoskeletal
– Painless erythematous papule and macules in
the palms and soles
– Painful erythematoue subcutaneous nodules
in the pulp space of the fingers and toes
– Petechiae haemorrhages
– Splinter haemaorrhages
• Splenomegaly
• Flame shaped retinal haemorrhages with
pale centre-ROTH SPOTS

12. Diagnosis
• Diagnosis is made using the duke criteria

13. investigations
• Blood cultures
– Are positive in 85 to 90% of pt
– Collect up to 6 specimens
• Echocardiogram
– Useful to demonstrate vegetations
– And evaluate valvular damage and ventricular
function

14. • Other tests
– FBC
– Serum creatinine
– CXR
– ECG
– C-reactive proteins
– ESR

16. Major complications of
endocarditis
• Congestive heart failure
• Embolism
– CNS-leads to CVAs, Seizure disorders, brain
abscess
– KIDNEYS-may manifest with haematuria
– SPLEEN- splenic infarcts

17. Management
• Two aspects
– Medical and
– Surgical management.
• Medical management
– Antibiotic therapy should be commenced
– Aim the initial antibiotic therapy at the most likely
cause.

19. • Surgical treatment
– Indications for cardiac surgery in pt with
endocarditis include
• Moderate to severe heart failure with valve
dysfucntion
• Fungal endocarditis

21. Prophylaxis
• Cardiac conditions for which prophylaxis is
indicated include
– High risk
– And low risk factors

22. HIGH RISK
• Prosthetic heart valves
• Prior bacterial endocarditis
• Complex cyanotic congenital
heart disease;
• lesions after correction
• Patent ductus arteriosus
• Coarctation of the aorta
• Surgically constructed
systemicpulmonary shunts
MODERATE
• Congenital cardiac malformations
• ventricular septal defect,
• bicuspid aortic valve
• Acquired aortic and mitral valve
dysfunction
• Hypertrophic cardiomyopathy
• Mitral valve prolapse with
valvular regurgitation