Endocarditis is an inflammatory disease involving the inner lining ( endocardium Endocardium The innermost layer of the heart, comprised of endothelial cells. Heart: Anatomy) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship may present with nonspecific symptoms such as fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever and fatigue Fatigue The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. Fibromyalgia. Important clinical exam findings include a new or changed heart murmur and common extra-cardiac signs, such as Osler nodes, Janeway lesions, splinter hemorrhages, and Roth spots. The diagnosis is based on clinical findings, blood cultures, and echocardiography Echocardiography Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. Tricuspid Valve Atresia (TVA) showing valvular vegetations. Management includes intravenous antibiotics for infectious cases, addressing the underlying etiology for noninfectious cases, and surgical repair when necessary.
Last updated: Oct 13, 2022
Infective endocarditis may be caused by numerous organisms; the list below is not exhaustive.
The following are risk factors for IE:
Infective endocarditis can be further classified based on the clinical course, type of valve, and location.
Acute infectious endocarditis:
Subacute infectious endocarditis (endocarditis lenta):
Native valve endocarditis:
Right-sided endocarditis (most common in IV drug use):
Presentation and course depend on the etiology, location of vegetations, and severity.
The following are more frequently seen in IE than NIE:
The following are potential findings in IE:
Signs of IE can be remembered with the mnemonic “FROM JANE”:
System embolization Embolization A method of hemostasis utilizing various agents such as gelfoam, silastic, metal, glass, or plastic pellets, autologous clot, fat, and muscle as emboli. It has been used in the treatment of spinal cord and intracranial arteriovenous malformations, renal arteriovenous fistulas, gastrointestinal bleeding, epistaxis, hypersplenism, certain highly vascular tumors, traumatic rupture of blood vessels, and control of operative hemorrhage. Gastrointestinal Bleeding may occur in both IE and NIE. Often, an embolic event is the only presenting evidence of NIE.
The Duke diagnostic criteria is a set of clinical criteria that can aid in the diagnosis of IE.
Prompt initiation of IV antibiotics is necessary if the patient is acutely ill.
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