Presentation

1. LEARNING OBJECTIVES
• DEFINITION
• TYPES
• ETIOLOGY & PATHOPHYSIOLOGY
• DIFF BTW SUBACUTE AND ACUTE ENDOCARDITIS
• WORKUP
• DUKE’S CRITERIA
• TREATMENT & COMPLICATIONS
PRESENTED BY:
DR. IMAMAH
FAKHIRA
INFECTIVE ENDOCARDITIS

2. INTRODUCTION:-
■ It is a bacterial, viral or fungal infection of endocardial surfaces of heart that
involves:
■ 1 or more cardiac valve
■ Mural endocardium
■ A septal defect
TYPES:-
■ Native valve endocarditis (subacute & acute)
■ Prosthetic valve endocarditis (early & late)
■ Intravenous drug abuse endocarditis
■ Pacemaker infective endocarditis
■ Nosocomial infective endocarditis

3.  STAPH AUREUS
 STREP VIRIDANS (MOST
COMMON)
 GROUP A, B STREPTOCOCCI
 ENTEROCOCCI
RISK FACTORS:-
 Younger age
 Male sex
 CKD
 Mod. AR
 Surgical procedures
ETIOLOGY:-

4. PATHOPHYSIOLOGY:-
IT IS A COMMONLY SHARED PROCESS;
1. Bacteremia that delivers organisms to the surface of valves.
2. Adherence of organisms
3. Eventual invasion of valvular leaflets.
These organisms resist the bactericidal action of compliment system & possess fibronectin
for surface of fibrin-platelet thrombus.
Some invasive procedures may cause bacteremia:-
■ Endoscopy
■ Colonoscopy
■ Barium enema
■ Dental extractions (most common)
■ TURP
■ Transesophageal echocardiography

5. SIGNS AND SYMPTOMS:-
■ Fever (low grade and intermittent)
■ Heart murmurs
■ Petechiae
■ Splinter hemorrhages (dark red, linear lesions in nail beds)
■ Osler nodes (tenderness in distal pads of digits)
■ Janeway lesions (non-tender maculae on palms and soles)
■ Roth spots (retinal hemorrhages)
SIGNS OF NEUROLOGICAL DISEASE
 Embolic stroke
 Intracerebral hemorrhage
 Multiple micro abcesses

6. OTHER COMMON SIGNS:-
■ Splenomegaly
■ Stiff neck
■ Pallor
■ Cardiac arrhythmias
■ Pericardial rub
■ Low grade fever
■ Anorexia
■ Weight loss
■ Pleuritic pain
■ Abdominal symptoms

7. DIFF BTW SUB ACUTE AND ACUTE INFECTIVE ENDOCARDITIS
SUB ACUTE
■ Symptom onset to diagnosis 4
weeks
■ 1 year survival
■ Caused by Viridans
■ RHD, CHD
■ Murmurs (99%) except in right sided
IE (1/3)
■ Low or no fever, night sweats
■ Fatigue, weight loss
■ Petechiae, subungual hemorrhages,
osler nodes, roth spots, clubbing,
arthritis, splenomegaly
■ Anemia, decrease C3,C4, CH50,
elevated gamma globulins
■ Leukopenia
ACUTE
■ Symptoms onset to diagnosis 1
week
■ 6-8 weeks survival
■ Caused by S. Aureus
■ Heart may be normal
■ No murmurs
■ Fever always high grade
■ Acute malaise
■ Shaking chills
■ Janeway lesions
■ Normal gamma globulins
■ Leukocytosis
■ Rheumatoid factor+

8. DIAGNOSIS:-
Diagnosis is made through DUKE’S CRITERIA
■ MAJOR CRITERIA BLOOD
• Two blood cultures positive for organism
• Positive blood culture for one organism (more than 12 hours apart)
• Three or more separate blood cultures drawn 1 hour apart
■ MAJOR CRITERIA ECHO
• Myocardial abscess
• New onset valvular regurgitation
• Partial dehiscence of a prosthetic valve

9. ■ MINOR CRITERIA
• IV drug use
• Fever 100.4 or up
• Vascular phenomenon:-
• Major artery emboli, septic pulmonary infarction, ischemic heart disease,
Janeway lesions
• Immunologic phenomenon:-
• Glomerulonephritis, osler nodes, roth spots, rheumatoid factor
• Positive blood cultures
• Echo
• Last two not meeting the major criteria

10. FOR DIAGNOSIS
TWO MAJOR CRITERIAS
ONE MAJOR, 3 MINOR CRITERIAS
5 MINOR CRITERIAS

11. WORK UP:-
1. Blood and urine studies
• CBC
• Serum electrolytes
• Bun
• BSR
• Coagulation profile
2. Blood cultures
3. Echo
• Vegetations
4. Radiography
• Multiple embolic pyogenic abscesses

12. TREATMENT & MANAGEMENT:-
Treatment of CCF
Supplemental Oxygenation
Hemodialysis in setting of renal failure
 Antibiotic therapy
 Ampicillin, Flucloxacillin and Gentamycin
 vancomycin + Gentamycin (if Penicillin resistant)
 Native valve
 (staphs)=> flucloxacillin, if allergic vancomycin 4 weeks
 Prosthetic valves (staphs)=> flucloxacillin + rifampicin = gentamycin 6 weeks
 Streps resistant to penicillin=> benzylpenicillin
 Streps less resistant=> benzylpenicillin + gentamycin
 Enterococci=> amoxicillin + gentamycin
 HACEK=> ceftriaxone
 Fungal (candida) => amphotericin, (aspergillus) => voriconazole

13.  SURGERY:-
 If
• Heart failure
• Valvular obstruction
• Repeated emboli
• Fungal IE
• Persistent bacteremia
• Myocardial abscess

14. COMPLICATIONS:-
■ MI
■ Arrhythmias
■ CCF
■ Mesenteric or septic abscess
■ Stroke syndromes
■ Arthritis
■ Myositis
■ Arterial emboli

15. DDs:-
■ Fever of unknown origin
■ Pulmonary embolism
■ DVT
■ Pneumonia
■ Acute heart failure
■ Meningitis
■ Sepsis
■ Stroke
■ Arrhythmias

16. PREVENTION:-
■ Patient education
■ Antibiotic prophylaxis
■ Avoidance of invasive procedures
■ Maintaining good oral health
■ Monitoring of high risk patients

17. THANKYOU!