Infective Endocarditis

Last Updated on by frcemuser

Risk factors:

  • Valvular heart disease
  • Prosthetic valves
  • Structural congenital heart disease
  • Rheumatic heart disease
  • Previous infective endocarditis
  • Hypertrophic cardiomyopathy
  • Intravenous drug use (IVDU)
  • Invasive vascular procedures

Common organisms:

  • Staphylococcus aureus (most common cause overall – acute and subacute IE)
  • Streptococcus viridans (most common cause of subacute IE)
  • Pseudomonas aeruginosa
  • HACEK (Haemophilus spp.,Aggregatibacter actinomycetemcomitans, Cardiobacterium spp., Eikenella
    corrodens, Kingella kingae)

Clinical features:

  • Fever
  • New heart murmur
  • Non-specific systemic features e.g. malaise, anorexia, weight loss, sweats, myalgia
  • Arthritis
  • Splenomegaly
  • Signs
    • Splinter (subungual) haemorrhagesClubbing
    • Roth’s spots (retinal haemorrhages with pale centres)
    • Osler nodes (small tender red-to-purple nodules on the pulp of the terminal phalanges of the fingers
      and toes)
    • Janeway’s lesions (irregular painless erythematous macules on the thenar and hypothenar eminence)

Investigations:

  • Echo – initially transthoracic, TOE is more sensitive
  • Blood cultures (x 3 at different sites and times, and preferably during fever)
  • FBC/CRP (nonspecificfic raised inflammatory markers)

Management:

  • Empirical antibiotics according to local protocol
  • Refer urgently to cardiology

Complications

  • Congestive heart failure
  • Systemic embolisation (emboli often involve the lungs, spleen, joints, brain, and coronary arteries)
  • Valvular dehiscence, rupture or fistula
  • Splenic abscess
  • Mycotic aneurysms

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