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Infective Endocarditis

Infective Endocarditis. Dr. Raid Jastania. Infective Endocarditis. Inflammation of the endocardium Common on heart valves Caused by infections: mostly bacteria Resulting in vegetations: thrombotic bebris and organism at the surface of the valve

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Infective Endocarditis

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  1. Infective Endocarditis Dr. Raid Jastania

  2. Infective Endocarditis • Inflammation of the endocardium • Common on heart valves • Caused by infections: mostly bacteria • Resulting in vegetations: thrombotic bebris and organism at the surface of the valve • Acute: high virulence organism, severe, acute, on normal healthy valves • Subacute: low virulence organism, mild, on diseased defective valves

  3. Infective Endocarditis • Route of infection • Bacteremia • IV drug abusers • Other source of infection: skin.. • Dental/surgical/catheterization

  4. Infective Endocarditis • Factors increasing the risk of endocarditis: • Pre-existing cardiac abnormlity • Valve disease: rheumatic valve disease, calcific aortic stenosis, mitral valve prolapse. • Hemodynamic trauma: small VSD • Prosthetic valve: 10-20% of cases • IV drug abusers: right side of heart

  5. Infective Endocarditis • Organisms: • Strep viridans: damaged valves 50-60% • Staph aureus: healthy and diseased valve 10-20% • Others: Hemophilus, Actinobacillus… • Prosthetic valve: Staph epidermidis, Gram negative, fungi • IV drug abusers: Staph aureus, Gram -ve

  6. Infective Endocarditis • Morphology: • Valve vegetations: • Bacteria/fibrin • Common on aortic and mitral • Single or multiple • More than one valve • Starts as small lesion and enlarges • Bulky friable lesion

  7. Infective Endocarditis • Morphology: • Valve vegetations • Destruction of valves: • Rupture of leaflets, cordae, or papillary muscle • Regurgitation • CHF • Extend to myocardium: • Ring abscess, inflammation, necrosis

  8. Infective Endocarditis • Morphology: • Valve vegetations • Destruction of valves: • Extend to myocardium: • Emboli: • Brain, kidneys…. • Abscess in brain kidneys….

  9. Infective Endocarditis • Morphology: • Valve vegetations • Destruction of valves: • Extend to myocardium: • Emboli • Subacute: less destruction, presence of granulation tissue and chronic inflammation

  10. Infective Endocarditis • Clinical: • Fever: • Low-grade in subacute • High-grade with chills in acute • Malaise, weight loss • Change in heart murmur • Clubbing of fingers • Emboli

  11. Infective Endocarditis • Complications: • Valve regurgitation • CHF • Myocardial abscess • Emboli • Systemic abscess • Mycotic aneurysm • Renal disease

  12. Nonbacterial Thrombotic Endocarditis

  13. Nonbacterial Thrombotic Endocarditis • Deposition of small masses of fibrin and platelets • On heart valves, common mitral • No organisms • No valve destruction or inflammation

  14. Nonbacterial Thrombotic Endocarditis • Pathogenesis • Endothelial injury • Hypercoagulable state • Malignancy in 50% of cases

  15. Nonbacterial Thrombotic Endocarditis • Morphology: • Vegetation: • multiple small nodules • Along valve closure • Normal healthy valves: aortic, mitral • Fibrin and platelets • No inflammation • May emboli

  16. Libman-Sacks Endocarditis

  17. Prosthetic Valves

  18. Prosthetic Valves • Bioprosthetic • Mechanical • Complications: • Both type: thrombosis, infective endocarditis • Bioprosthetic: calcification, stenosis, tear, regurgitation • Mechanical: hemolysis

  19. Pericardial Disease

  20. Pericarditis • Causes:

  21. Pericarditis • Causes: • Infections: mostly viruses, bacteria, fungi • Ischemic: following MI • Physical: Following surgery, radiation • Chemical: uremia • Immune: SLE • Malignancy: bloody effusion

  22. Pericarditis • Fate:

  23. Pericarditis • Fate: • Acute disease: immediate hemodynamic complications • Resolution • Chronic fibrosing pericarditis (constrictive pericarditis)

  24. Pericarditis • Clinical • Chest pain • Pericardial rub • Cardiac tamponade: weak heat sound, hypotension/shock, distended neck veins

  25. Pericardial Effusion • Accumulation of fluid in the pericardial space • Transudate VS. Exudate • Serous, serosanguineous, chylous, bloody • Hemopericardium: in rupture aortic aneurysm, rupture MI, traumatic injury

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