Endocarditis
Basics
Description
An inflammation of the endothelial surface of the heartDescription
- 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 thrombotic endocarditis or marantic endocarditis:
- Often due to a hypercoagulable state
- Small sterile vegetation
- Libman–Sacks endocarditis:
- Complications of lupus erythematosus
- Due to the deposition of immune complexes that cause an inflammatory reaction
- Small vegetation
- Nonbacterial thrombotic endocarditis or marantic endocarditis:
Epidemiology
Epidemiology
- More common in men:
- Incidence 3–7 cases/100,000 person-yr
- Third most common life-threatening infection
- Risk factors:
- Older patients
- Poor dental hygiene or dental procedure
- Comorbidities:
- Rheumatic and congenital heart disease
- Prosthetic valve/intracardiac device
- Hemodialysis/indwelling catheters
- Diabetes and immunosuppression
- 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
- Cerebral complications:
- 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
- Structural heart disease serves as common vegetative site due to altered intracardiac flow:
Etiology
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
- Acute and destructive
- 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.) slow growing
- Culture-negative endocarditis (Q fever, psittacosis, Bartonella, brucellosis)
- Staphylococcus aureus (most common pathogen):
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Schaider, Jeffrey J., et al., editors. "Endocarditis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307224/all/Endocarditis.
Endocarditis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307224/all/Endocarditis. Accessed December 11, 2024.
Endocarditis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307224/all/Endocarditis
Endocarditis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 11]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307224/all/Endocarditis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Endocarditis
ID - 307224
ED - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307224/all/Endocarditis
PB - Lippincott Williams & Wilkins
ET - 6
DB - Emergency Central
DP - Unbound Medicine
ER -