1 / 29

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

gerry
Download Presentation

Infective Endocarditis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related