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Infective edocarditis

Infective edocarditis. Definition. an infection of the endocardium or vascular endothelium it may occur as fulminating or acute infection more commonly runs as subacute bacterial endocarditis (SBE). SBE occurs. on rheumatic or congenitally abnormal valves in mitral valve prolapse

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Infective edocarditis

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  1. Infective edocarditis

  2. Definition an infection of the endocardium or vascular endothelium it may occur as fulminating or acute infection more commonly runs as subacute bacterial endocarditis (SBE)

  3. SBE occurs • on rheumatic or congenitally abnormal valves • in mitral valve prolapse • in calcified aortic valve Congenital lesions: • ventricular septal defect (VSD) • Persistent ductus arteriosus (PDA) Prosthetic valves

  4. The lesion of infective endocarditis is a mass of fibrin, platelets and infecting organisms known as a vegetation.

  5. Aetiology • Streptococcus viridans (50%) • Enterococcus faecalis • Staphylococcus aureus (50% of acute cases) • Staphylococcus epidermidis • Coxiella burnetti • Gram-negative

  6. Subacute endocarditis • Fever • Night sweats • Weight loss • Weakness • Cardiac failure • Embolism • Heart murmur • Onset of the disease is unknown

  7. Acute endocarditis • Intravenous drug abusers • Following an acute suppurative illness • Persistence of fever • Development of heart murmur • Vasculitis • Metastatic abscesses • The onset of the illness: chordal rupture or acute valvular destruction

  8. Prosthetic endocarditis • develops soon after surgery • Occurs late and follows a bacteraemia • In both cases the valve ring in infected

  9. Clinical features Endocarditis must be suspected in a patients with a heart murmur and a fever

  10. Cardiac findings development of a new murmur or a change in the charakter of an existing murmur

  11. Vascular lesions • Vasculitis (small petechial or mucosal haemorrhages, they are small, red, usually with a pale center, when seen on the retin – Roth spots, seen on the thenar or hypothenar eminences - Janeway lesions • Embolic lesions (hard, painful, tender, subcutaneous swellings occurs in the fingers, toes, palms and soles (Osler’ nodes)

  12. Clinical Features • Clubbing of the fingers • Splenomegaly • Renal lesions (haematuria, proteinuria) • Arthritis • Infarcts

  13. Investigaion • Blood (anaemia, leucocytosis, CRP) • Liver biochemistry in often but mildly disturbed • Immunoglobulins are increased • Total complement and C3 are decreased • Urine:protein and blood (microscopic haematuria)

  14. Echocardiography • Is used to visualize vegetations • To document valvular dysfunction • To identify patients in need of urgent surgery

  15. Drug therapy • Antibiotics are chosen on the basis of the results of the blood culture • The treatment should continue 4-6 weeks

  16. Surgical treatment • Extensive damage to a valve • Early infection of prosthetic material • Worsening renal failure • Persistent infection • Large vegetations • Progressive cardiac failure

  17. Congenital heart disease

  18. Aetiology • Maternal rubella infection • Maternal alcohol abuse • Maternal drug treatment and radiation • Genetic abnormalities • Chromosomal abnormalities (Turner’s and Down’s syndrome)

  19. Symptoms • Central cyanosis • Pulmonary hypertension • Clubbing of the fingers • Paradoxical embolism • Reduced growth • syncope

  20. Treatment • A significant ASD (pulmonary flow that in more than 50 % is increased when compare with systemic flow)

  21. Ventrical septal defect • Left ventricular pressure (LVP) is higher than RVP  blood moves from LV to RV and pulmonary blood flow   obliterative pulmonary vascular changes may cause the pulmonary arterial pressure to equal the systemic pressure (Eisenmenger’s syndrome)  the shunt is reduced or reversed and central cyanosis may develop

  22. Clinical features Small VSD • systolic murmur • Asymptomatic patients • Usually close spontaneously Moderate VSD • Laud systolic murmur • Some fatigue and dyspnoea • Cardiac enlargement and prominent apex beat

  23. Treatment • Surgery (moderate and large VSD) • Prophylaxis of endocarditis

  24. Atrial Septal defect (ASD) • Type I ostium secundumsystolic murmur • Type II ostium primum • Common form of ASD is type I

  25. Clinical features Children • Most children are asymptomatic • Pulmonary infection • Dyspnoe and weakness

  26. Clinical features • Age > 30: • AF • RVH  RVF • Second sound is wide and fixed • Loud ejection systolic pulmonary flow murmur

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