Infectious endocarditis

6 Interesting Facts of Infectious endocarditis

  1. Infection of heart valves and myocardium
  2. Mitral valvular vegetations (eg, accretions of bacteria, fibrin, and platelets) on rare occasion can be large enough to impede blood flow, mimicking mitral stenosis
  3. Presents with dyspnea, congestive cardiac failure, heart murmurs, palpitations, systemic embolism, and low-grade fever
  4. Most commonly seen in rheumatic heart disease
  5. Blood culture results are positive in almost 90% of cases 4
  6. Differentiated with echocardiography; helps to confirm the diagnosis by detecting valvular vegetations, valvular dehiscence, periannular tissue destruction, and leaflet perforation
  • Endocarditis due to MRSA is usually acute in onset and progresses rapidly to severe disease; differential diagnosis includes the following:
    • Sepsis Staphylococcus aureus
      • Syndrome of organ dysfunction in conjunction with a dysregulated host response
      • Characterized by fever, hemodynamic instability, and toxic appearance
      • Other potential sources may be identified (eg, abdominal pain, pyuria, infiltrate on chest radiograph)
      • Distinguished by blood culture results and echocardiographic criteria
    • Myocardial infarction (Related: Acute coronary syndromes)
      • Myocardial necrosis resulting from occlusion of a coronary artery
      • Presenting features may include dyspnea and fatigue
      • Usually can be differentiated by presence of retrosternal chest pain and/or pressure radiating to neck, jaw, shoulder, and/or arm
      • Diagnosed by ECG showing ST elevation, ST depression, or T wave inversion; elevated cardiac troponin level
      • Myocardial infarction can occur concurrently with endocarditis, owing to embolization of vegetation into a coronary artery
    • Pulmonary embolism
      • Sudden occlusion of a pulmonary artery, most often due to a dislodged thrombus
      • As with endocarditis, presenting symptoms may include dyspnea and tachypnea
      • Onset of symptoms is abrupt, and pleuritic chest pain is common
      • Diagnosed by multidetector-row CT angiography or CT pulmonary angiography; D-dimer levels are usually elevated
      • May occur concurrently with tricuspid endocarditis, owing to embolization of a vegetation
  • Endocarditis due to MRSE usually is somewhat more indolent; differential includes subacute or chronic systemic conditions, as follows:
    • Lymphoma
      • Heterogeneous group of lymphoproliferative disorders characterized by aberrant proliferation of lymphocytes
      • Clinical features may include fevers, weight loss, and night sweats
      • Unlike with endocarditis, regional or diffuse lymphadenopathy can usually be detected
      • Diagnosis is by biopsy
    • Primary cardiac tumors
      • Although atrial myxoma is most common, other malignant or benign tumors can develop in the heart
      • May present with symptoms of embolization, intracardiac obstruction (heart failure or syncope), and constitutional symptoms
      • Chest radiograph may show tumor calcification
      • Echocardiography is diagnostic and finds tumors such as the following:
        • Atrial myxoma as a well-defined, pedunculated, mobile mass attached to atrial septum, near fossa ovalis
        • Malignant tumor as invasive sessile mass with broad-based attachment
      • Histologic examination of the tumor is confirmatory
    • Systemic lupus erythematosus
      • Chronic multisystem disease of autoimmune origin affecting joints and skin (and sometimes other systems)
      • Clinical manifestations may include malar rash, arthritis, renal dysfunction, and neurologic involvement
      • Positive results for antinuclear antibody and anti-dsDNA antibody testing confirm the diagnosis
      • Echocardiography may show broad-based Libman-Sacks vegetations less than 1 cm in diameter, without independent motion characteristics, unlike vegetations of infective endocarditis


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