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Endocarditis (Pathoma) (Clinical Features (Murmur (vegetations across…
Endocarditis (Pathoma)
Definition
Inflammation of endocardium (lining surf of cardiac valves)
usually due to bact infx
S. Viridans
#1 most common overall cause
subacute endocarditis
low virulence organism,
can only
infect previously damaged valves
Results in small vegetations that do not destroy valve
RH disease or
mitral valve prolapse
preexisting
Pathogenesis
damaged endocardial surf
(subendo. collagen) develops thrombotic vegetations (platelets + fibrin)
vegetations act as a trap, snagging transient bacteria (like after a new dental procedure)
S. Aureus
#1 most common cause of IE in IV drug users
enters through contaminated skin "shooting up"
Acute: high virulence organism infecting normal valves
classically Tricuspid
Results in large vegetations that destroy the valve
causing Acute Endocarditis
does occur w/o preexisting valvular heart condition
S. Epidermidis
mainly endocarditis affecting prosthetic valves
repeat surgery, Abx are ineffective
S. Bovis
causes IE in patents w/ CRC
Lacefield group D
S. Gallolyticus is most strongly associated
IE with negative blood cultures (hard to grow)
HACEK organisms
Hemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
Coxiella Burnetti
Bartonella
Clinical Features
fever
Murmur
vegetations across cardiac valve disrupts flow
septic embolizations on the vegetations, from falling off the valve and entering systemic circ
Complication: Janeway Lesions
(erythematous nontender lesions on palms/soles)
Complication: Osler nodes
(painful lesions on fingers/toes)
mnemonic: "ouch, ouch, Osler!
Complication: splinter hemorrhages in nail bed
Complication: Roth spot
retinal lesion
Red w// pale center
Duke Criteria: 2 major or at least 3 minor
Major: (+) blood culture, Veg on echo
Minor: fever, risk factors,
these emboli symptoms
Anemia of chronic disease
chronic inflamm due to IE is cause
Weird complication
access beneath
valve annulus
bacteria hide here
growth causes damage to
AVN
AVN dysfunction
AVN heart block
1º or 2º wenkebach
Lab Findings
positive blood cultures
findings of Anemia of chronic disese
(microcytic anemia)
low hemoglobin
low MCV (its microcytic!)
acute phase reactants from liver
Hepcidin (traps iron in storage sites)
Ferritin is therefore high
TIBC is low
Bone marrow takes iron from blood
Serum iron decreases
% saturation decreases
TEE useful for lesion detection
Nonbacterial Thrombotic Endocarditis:
NBTE
sterile vegetations
on both sides
assd. hyper coagulable state
assd. underlying adenocarcinoma
usually arise on Mitral valve/ lines of closure
results: regurgitation
rarely (not really assd): regurgitation or murmurs
assd. w/ SLE
Libman-Sacks Endocarditis
sterile vegetations
vegetations present on both sides of the cardiac valve (Highly Characteristic!)
Emboli
usually asymptomatic
if emboli forms
spleen, kidney, skin, extremities
stroke
MI
Enterococcus
Lacefield Group D
Older men with GI sx or GU cath
Subacute course: part of normal flora
TURP
