Internal Diseases and Therapy · MU Sofia

17. Endocarditis

Covers infective endocarditis, from definition and classification by course, site and acquisition to causative organisms, predisposing factors and pathogenesis. Clinical features, the Duke-ISCVID and ESC 2023 diagnostic criteria, imaging and treatment, including antibiotic regimens and surgical indications, are followed by complications, prognosis, prevention and the non-infective forms. It includes several comparison tables, a list of peripheral stigmata, and photographs of valve pathology and Janeway lesions.

Inside: 12 sections · 3 labelled pictures · 6 tables · 15 flashcards · 14 min

Topic 17 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 12 sections, about 1,364 words (14 min of reading), with 15 flashcards.

In this note

  1. Definition
  2. Classification of infective endocarditis
  3. Etiology
  4. Pathogenesis
  5. Clinical features
  6. Diagnosis
  7. Differential diagnosis
  8. Treatment
  9. Complications
  10. Prognosis
  11. Prevention (ESC 2023)
  12. Non-infective endocarditis

Definition

Endocarditis is inflammation of the endocardium, mostly of the heart valves, but also of the chordae, septal defects, mural endocardium and intracardiac material (prosthetic valves, device leads). Its lesion is the vegetation, a mass of platelets and fibrin that in infection also holds microorganisms.

  • Infective endocarditis (IE): microbial infection of the endocardial surface, usually bacterial, rarely fungal. The main subject of this topic.
  • Non-infective endocarditis: sterile vegetations (marantic, Libman–Sacks; rheumatic valvulitis, see topic 36).
  • Incidence of IE about 3–10 per 100,000 per year and rising (older patients, more prosthetic valves, devices and healthcare-associated infection); men about twice as often.

Gross pathology of subacute bacterial endocarditis caused by Haemophilus parainfluenzae (a HACEK organism): friable vegetations on the mitral valve leaflets.

Image: “Haemophilus parainfluenzae Endocarditis PHIL 851 lores” by unknown author, Public domain, via Wikimedia Commons.

Etiology

Microorganisms

Predisposing factors

  • High risk: previous IE, prosthetic valve (surgical or transcatheter) or valve repair material, untreated cyanotic or prosthetically repaired congenital heart disease, ventricular assist device.
  • Intermediate risk: rheumatic or degenerative valve disease, bicuspid aortic valve and other congenital valve lesions, mitral valve prolapse with regurgitation, pacemakers and defibrillators, hypertrophic cardiomyopathy.
  • Non-cardiac: injection drug use, haemodialysis, central venous catheters, poor dental hygiene, invasive procedures, diabetes, immunosuppression, old age. About half have no known heart disease (especially S. aureus IE).

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