Endocarditis

Posted On March 7, 2021

Overview

Inflammation of endocardium
- Non infective endocarditis
  - Lieman Sacks Endocarditis from SLE, from autoimmune disease
- Bacterial endocarditis –
  - bacterial enters blood stream
    - Skin: iv catheter, iv drug – Staph
    - Gums: dental procedure, V Strep
    - Guts: colon cancer, ulcerative colitis – Enterococcus
Most commonly affected
- Mitral valve
- Aortic valve

Risk factors

Prosthetic valves
Congenital heart defects
Rheumatic heart disease
Intravenous drug use

Infective endocarditis: Signs and Symptoms

Fever, heart murmur
Splinter hemorrhages: small bleed under a nail
Janeway lesions
Antigen Antibody complexes
- Fingers and toes, Oslers nodes
- Retina: Roth spot
- Kidneys: glomerulonephritis

Dx and Rx

Blood cultures x3, positive in over 90%
Echocardiogram – heart valve vegetations
ID, Cardiology and Cardiac surgery consults
Rx:
- Empiric antibiotics after blood cultures sent:
  - native heart: usually vancomycin
  - prosthetic valves: vancomycin, gentamicin and either cefepime or a carbapenem
  - usual length of therapy 6 weeks
  - some may need cardiac surgery: congestive heart failure, heart block, system emboli

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