0071643192.pdf

Risk factors for endocarditis include:

■ Congenital heart disease
■ Rheumatic heart disease
■ Injection drug use (IDU)
■ Prosthetic valves
■ Mitral valve prolapse with regurgitation
■ Presence of a cardiac pacemaker

PATHOPHYSIOLOGY

■ The presence of a foreign body or the disruption of normal flow through
the valves →turbulence→platelet aggregation and fibrinogenesis.
■ These sterile vegetations are subsequently colonized by bacteria leading to
infection and valvular destruction (see Table 2.15).

SYMPTOMS

■ Fever (most common): But absence of fever does not rule out endocarditis
■ Malaise, weakness
■ Body aches, back pain
■ Dyspnea

EXAM

■ Fever (most common)
■ Regurgitation murmur
■ Vascular phenomena
■ Septic pulmonary emboli (R-sided disease)
■ CNS emboli (L-sided disease) →hemiplegia, aphasia
■ Janeway lesions—nontender erythematous macules on palms, soles, or
fingers

CARDIOVASCULAR EMERGENCIES

TABLE 2.15. Etiologies of Endocarditis

PREDISPOSINGFACTORS LOCATION USUALPATHOGENS

Prosthetic valve Replaced valve Staphylococcussp.a

<60 days (early) Enterobacteriaceae

Diphtheroids

Fungi

IDU Tricuspid valve most often Staphylococcus aureus

Native valve Mitral >aortic >>tricuspid Streptococci (viridans or others)a

Staphylococci

Enterococci

Prosthetic valve Replaced valve Same as native valve

>60 days (late)

Pacemaker, Infection of pacemaker Staphylococcus aureus

implantable pocket, leads Staphylococcus epidermidis

defibrillator

aMost common organism

R-sided endocarditis—think

IVDA, acute/fulminant course,

S. aureus.

L-sided endocarditis—think

native valve disease, indolent

course, Streptococci.