Endocarditis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

An inflammation of the endothelial surface of the heart
  • Various cardiac structures may be involved:
    • Native heart valves (most common)
    • Prosthetic valves
    • Interventricular septum
    • Chordae tendineae
    • Mural endocardium
    • Intracardiac devices
  • Characterized by a vegetation (a thrombus with superimposed microorganisms)
    • Bacterial colonization of the initially sterile vegetation composed of fibrin and platelets
    • Bacterial growth enlarges the vegetation, further impeding blood flow and inciting inflammation.
    • Propagation of the infection through systemic emboli
  • Almost always secondary to bacterial infection
  • Rare noninfectious causes
    • Nonbacterial thrombic endocarditis or marantic endocarditis
      • Often due to a hypercoagulable state
      • Small sterile vegetations
    • Libman–Sacks endocarditis
      • Complications of lupus erythematosus
      • Due to the deposition of immune complexes that cause an inflammatory reaction
      • Small vegetations

Epidemiology

  • More common in men (ratios from 3.2 to 9.1)
    • M: 8.6–12.7 cases/100,000 person-yr
    • F: 1.4–6.7 cases/100,000 person-yr
  • Risk factors:
    • Older patients
    • Poor dental hygiene
    • Comorbidities
      • Rheumatic heart disease
      • Prosthetic valve
      • Hemodialysis
      • Diabetes
    • IV drug abuse (IVDA):
      • Greater risk than rheumatic heart disease or prosthetic valves
      • Predilection for right-sided heart valves
  • Septic embolization
    • Cerebral complications
      • Cerebral embolism
      • Intracranial hemorrhage
      • Cerebral abscess
    • Extracerebral embolic events
      • Pulmonary
      • Splenic
      • Renal
      • Mycotic aneurysms (aorta, renal artery, splenic artery, hepatic artery, mesenteric arteries, etc.)
      • Hepatic
      • Coronary
  • Risk factor for recurrent endocarditis:
    • Structural heart disease serves as common vegetative site due to altered intracardiac flow:
      • Mitral valve prolapse
      • Aortic valve dysfunction
    • Congenital heart disorders in the pediatric populations:
      • Tetralogy of Fallot
      • Aortic stenosis
      • Patent ductus arteriosus
      • Ventricular septal defects
      • Aortic coarctation
    • Prosthetic valves
    • Indwelling catheters
    • Any mechanical device may serve as a portal of entry or attachment for microorganisms.

Etiology

  • Major categories:
    • Bacterial endocarditis
    • Prosthetic valve endocarditis
    • Nonbacterial thrombotic endocarditis:
      • Malignancy
      • Uremia
      • Burns
      • Systemic lupus erythematosus
  • Common organisms:
    • Staphylococcus aureus (most common pathogen):
      • Seen in all populations, especially IVDA and toxic illness
      • Sometimes metastatic
    • Streptococcus viridans:
      • Found in oropharynx, common agent in native valve endocarditis
    • Streptococcus bovis:
      • Common association with colonic polyps or GI malignancy
    • Streptococcus pneumoniae:
      • Causes rapid valvular destruction, abscess, and CHF
      • Risk factor: Alcoholism
    • Staphylococcus epidermidis
    • Enterococci:
      • Seen in young women and old men following instrumentation or infection
    • Candida and Aspergillus:
      • Found in IVDA, prosthetic valves, or immunocompromised patients
    • HACEK (Haemophilus sp.)
    • Culture-negative endocarditis (Q fever, psittacosis, Bartonella, brucellosis)

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Citation

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TY - ELEC T1 - Endocarditis ID - 307224 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307224/all/Endocarditis ER -