Endocarditis
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Introduction
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Rheumatic fever used to be most common cause.
Congenital heart disease is now the most common.
IVDU:
nonIVDU:
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prosthetic (< 6 mo) - acquired at time of surgery
prosthetic (> 6 mo):
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HACEK
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Pathophysiology
Grow in eddies; these are most commonly near the valves.
Signs and Symptoms
A low-grade fever is the most common symptom, often on its own.
Janeway lesions and splinter hemorrhages.
Duke's Criteria - 2 major, or 1 major and 3 minor, or 5 major
Major
- Bacteremia with a pathogen known to cause IE
- vegetations on echo and new regurgitant murmur
Minor
- septic emboli: Janeway lesions, infarcts
- immune manifestations
- previous IE
- risk factors
- history
- physical exam
History
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Bloodwork includes:
- CBC
- ESR, CRP
Do at least three sets of blood cultures, separated by time.
Urinalysis, as IE can often cause renal involvement. Look for signs of glomerulonephritis or emboli.
Diagnostic Imaging
Echocardiography can be done transthoracically or transesophageallu
Differential Diagnosis
Treatments
Antibiotic treatment will depend on the source, identified via culture.
Vancomycin + gentamycin are appropriate for emperic therapy.
- gram positives:
- gram negatives:
- fungi:
Valve replacement may be indicated in patients with substantial, intractable growth of vegetation.
Consequences and Course
The most serious complications include emboli and mycotic aneurysms, leading to cerebral, splenic, or bowel infarction.
Valvular regurgitation can lead to congestive heart failure. Abscess can lead to electrical deregulation and arrhythmia.
The Case of...
Case #2 - a small story wrapping it all up and asking especially about management.
Additional Resources
Topic Development
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