Endocarditis


Endocarditis is an inflammation of the inner layer of the heart, the endocardium It usually involves the heart valves Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or the surfaces of intracardiac devices Endocarditis is characterized by lesions, known as vegetations, which is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells1 In the subacute form of infective endocarditis, the vegetation may also include a center of granulomatous tissue, which may fibrose or calcify2

There are several ways to classify endocarditis The simplest classification is based on cause: either infective or non-infective, depending on whether a microorganism is the source of the inflammation or not Regardless, the diagnosis of endocarditis is based on clinical features, investigations such as an echocardiogram, and blood cultures demonstrating the presence of endocarditis-causing microorganisms Signs and symptoms include: fever, chills, sweating, malaise, weakness, anorexia, weight loss, splenomegaly, flu-like feeling, cardiac murmur, heart failure, petechia of anterior trunk, Janeway's lesions, etc

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Contents

  • 1 Cause
    • 11 Infective
    • 12 Non-infective
  • 2 Diagnostics
  • 3 References
  • 4 External links

Causeedit

Infectiveedit

Main article: Infective endocarditis

Since the valves of the heart do not receive any dedicated blood supply, defensive immune mechanisms such as white blood cells cannot directly reach the valves via the bloodstream If an organism such as bacteria attaches to a valve surface and forms a vegetation, the host immune response is blunted The lack of blood supply to the valves also has implications on treatment, since drugs also have difficulty reaching the infected valve

Normally, blood flows smoothly past these valves If they have been damaged from rheumatic fever, for example the risk of bacteria attachment is increased2

Rheumatic fever is common worldwide and responsible for many cases of damaged heart valves Chronic rheumatic heart disease is characterized by repeated inflammation with fibrinous resolution The cardinal anatomic changes of the valve include leaflet thickening, commissural fusion, and shortening and thickening of the tendinous cords3 The recurrence of rheumatic fever is relatively common in the absence of maintenance of low dose antibiotics, especially during the first three to five years after the first episode Heart complications may be long-term and severe, particularly if valves are involved While rheumatic fever since the advent of routine penicillin administration for Strep throat has become less common in developed countries, in the older generation and in much of the less-developed world, valvular disease including mitral valve prolapse, reinfection in the form of valvular endocarditis, and valve rupture from undertreated rheumatic fever continues to be a problem4

In an Indian hospital between 2004 and 2005, 4 of 24 endocarditis patients failed to demonstrate classic vegetation All had rheumatic heart disease and presented with prolonged fever All had severe eccentric mitral regurgitation One had severe aortic regurgitation also One had flail posterior mitral leaflet5

Non-infectiveedit

Nonbacterial thrombotic endocarditis NBTE, also called marantic endocarditis is most commonly found on previously undamaged valves2 As opposed to infective endocarditis, the vegetations in NBTE are small, sterile, and tend to aggregate along the edges of the valve or the cusps2 Also unlike infective endocarditis, NBTE does not cause an inflammation response from the body2 NBTE usually occurs during a hypercoagulable state such as system-wide bacterial infection, or pregnancy, though it is also sometimes seen in patients with venous catheters2 NBTE may also occur in patients with cancers, particularly mucinous adenocarcinoma2 where Trousseau syndrome can be encountered Typically NBTE does not cause many problems on its own, but parts of the vegetations may break off and embolize to the heart or brain, or they may serve as a focus where bacteria can lodge, thus causing infective endocarditis2

Another form of sterile endocarditis is termed Libman–Sacks endocarditis; this form occurs more often in patients with lupus erythematosus and is thought to be due to the deposition of immune complexes2 Like NBTE, Libman-Sacks endocarditis involves small vegetations, while infective endocarditis is composed of large vegetations2 These immune complexes precipitate an inflammation reaction, which helps to differentiate it from NBTE Also unlike NBTE, Libman-Sacks endocarditis does not seem to have a preferred location of deposition and may form on the undersurfaces of the valves or even on the endocardium2

An illustration depicting endocarditis

Diagnosticsedit

Examination of suspected infective endocarditis includes a detailed examination of the patient, complete history taking, and especially careful cardiac auscultation, various blood tests, ECG, cardiac ultrasound echocardiography Analysis of blood helps reveal the typical signs of inflammation increased erythrocyte sedimentation rate, leukocytosis Two or more separate blood cultures are normally drawn Negative blood cultures, however, do not exclude the diagnosis of infective endocarditis Echocardiography through the anterior chest wall or transesophageal, plays a decisive role in the diagnosis by reliably establishing the presence of microbial vegetation and the degree of valvular dysfunction affecting the pumping function of the heart6

Referencesedit

  1. ^ Kasper DL, Braunwald E, Fauci AS, Hauser S, Longo DL, Jameson JL May 2005 Harrison's Principles of Internal Medicine McGraw-Hill pp 731–40 ISBN 0-07-139140-1 OCLC 54501403 
  2. ^ a b c d e f g h i j k Mitchell RS, Kumar V, Robbins SL, Abbas AK, Fausto N 2007 Robbins Basic Pathology 8th ed Saunders/Elsevier pp 406–8 ISBN 1-4160-2973-7 
  3. ^ Cotran, Ramzi S; Kumar, Vinay; Fausto, Nelson; Robbins, Stanley L; Abbas, Abul K 2005 Robbins and Cotran pathologic basis of disease St Louis, Mo: Elsevier Saunders ISBN 0-7216-0187-1 
  4. ^ NLM/NIH: Medline Plus Medical Encyclopedia: Rheumatic fever
  5. ^ S Venkatesan; et al Sep–Oct 2007 "Can we diagnose Infective endocarditis without vegetation " Indian Heart Journal 59
  6. ^ http://medusanewscom/diseases-and-conditions/cardiology/endocarditishtmlfull citation needed

External linksedit

  • Endocarditis at DMOZ
  • Rodolico, Jack March 21, 2017 "Doctors Consider Ethics Of Costly Heart Surgery For People Addicted To Opioids" NHPR 
  • Tissières P, Gervaix A, Beghetti M, Jaeggi ET 2003 "Value and limitations of the von Reyn, Duke, and modified Duke criteria for the diagnosis of infective endocarditis in children" Pediatrics 112 6 Pt 1: e467 PMID 14654647 
  • Meine TJ, Nettles RE, Anderson DJ, Cabell CH, Corey GR, Sexton DJ, Wang A 2001 "Cardiac conduction abnormalities in endocarditis defined by the Duke criteria" American Heart Journal 142 2: 280–5 PMID 11479467 doi:101067/mhj2001116964 
  • Bouza E, Menasalvas A, Muñoz P, Vasallo FJ, del Mar Moreno M, García Fernández MA 2001 "Infective endocarditis--a prospective study at the end of the twentieth century: new predisposing conditions, new etiologic agents, and still a high mortality" Medicine 80 5: 298–307 PMID 11552083 


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