Endocarditis

Descripción General

Definición

• La endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa es causada por la infección o la inflamación del revestimiento interno del corazón (endocardio), que suele afectar a las válvulas cardíacas.
• La endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis no infecciosa es el resultado de la formación de trombos de plaquetas y fibrina estériles en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las válvulas cardíacas y el endocardio.

Epidemiología

Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa:

• La forma más común de endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis
• Incidencia: 11–15 casos por cada 100 000 personas al AL Amyloidosis año
• Edad media: 60,8 años (> 50% tienen > 50 años)
• 3 veces más frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hombres

Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis no infecciosa:

• Rara
• A menudo se encuentra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la autopsia
• Incidencia: 0,9%–1,6%
• Grupo de edad común: 30–70 años
• No hay predilección por el sexo

Etiologías de la endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa

La endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa puede estar causada por numerosos organismos; la lista que figura a continuación no es exhaustiva.

• Estafilococos:
  • Staphylococcus aureus Staphylococcus aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Brain Abscess (más común)
  • S. epidermidis S. epidermidis A species of staphylococcus that is a spherical, non-motile, gram-positive, chemoorganotrophic, facultative anaerobe. Mainly found on the skin and mucous membrane of warm-blooded animals, it can be primary pathogen or secondary invader. Staphylococcus
• Estreptococos:
  • Streptococcus viridans Streptococcus viridans A large heterogeneous group of mostly alpha-hemolytic streptococci. They colonize the respiratory tract at birth and generally have a low degree of pathogenicity. This group of species includes Streptococcus mitis; Streptococcus mutans; Streptococcus oralis; Streptococcus sanguis; Streptococcus sobrinus; and the Streptococcus milleri group. The latter are often beta-hemolytic and commonly produce invasive pyogenic infections including brain and abdominal abscesses. Brain Abscess (comúnmente después de procedimientos dentales)
  • S. pneumoniae
  • S. bovis (asociado al AL Amyloidosis cáncer de colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy)
• Grupo HACEK:
  • Haemophilus
  • Actinobacillus (ahora conocido como Aggregatibacter)
  • Cardiobacterium
  • Eikenella
  • Kingella
• Otras causas bacterianas:
  • Enterococcus Enterococcus Enterococcus is a genus of oval-shaped gram-positive cocci that are arranged in pairs or short chains. Distinguishing factors include optochin resistance and the presence of pyrrolidonyl arylamidase (PYR) and Lancefield D antigen. Enterococcus is part of the normal flora of the human GI tract. Enterococcus
  • Coxellia burnetii
  • Brucella Brucella Brucellosis (also known as undulant fever, Mediterranean fever, or Malta fever) is a zoonotic infection that spreads predominantly through ingestion of unpasteurized dairy products or direct contact with infected animal products. Clinical manifestations include fever, arthralgias, malaise, lymphadenopathy, and hepatosplenomegaly. Brucella/Brucellosis
  • Bartonella Bartonella Bartonella is a genus of gram-negative bacteria in the family Bartonellaceae. As a facultative intracellular parasite, Bartonella can infect healthy people as well as act as an opportunistic pathogen. Bartonella species are transmitted by vectors such as ticks, fleas, sandflies, and mosquitoes. B. henselae is the most common of the 3 species known to cause human disease. Bartonella
• Hongos:
  • Candida albicans Candida albicans A unicellular budding fungus which is the principal pathogenic species causing candidiasis (moniliasis). Candida/Candidiasis
  • Aspergillus Aspergillus A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family trichocomaceae. Echinocandins

Etiologías de endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis no infecciosas

• Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis de Libman-Sacks:
  • Debido a los LOS Neisseria complejos inmunes circulantes
  • Asociado con:
    • Lupus eritematoso sistémico
    • Síndrome antifosfolípido
  • Afecta a la válvula mitral > aórtica
• Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis trombótica (marántica):
  • Malignidad (debido a metástasis que penetran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las válvulas del corazón)
  • Estados hipercoagulables
  • Enfermedad de desgaste crónico
  • Infecciones crónicas (e.g., tuberculosis Tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis)
• Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis reumática:
  • Por reacción antígeno-anticuerpo tras una faringitis por estreptococo del grupo A
  • Afecta a la válvula mitral > aórtica
• Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis de Löffler:
  • Asociada al AL Amyloidosis síndrome hipereosinofílico
  • Debida a la infiltración eosinofílica y al AL Amyloidosis daño tisular
• Traumatismos iatrogénicos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las válvulas cardíacas
• Otras afecciones autoinmunes (poco frecuentes):
  • Enfermedad de Behcet
  • Artritis reumatoide
  • Esclerodermia sistémica
  • Vasculitis Vasculitis Inflammation of any one of the blood vessels, including the arteries; veins; and rest of the vasculature system in the body. Systemic Lupus Erythematosus

Factores de Riesgo y Fisiopatología

Factores de riesgo

Los LOS Neisseria siguientes son factores de riesgo para la endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa:

• Enfermedades cardíacas:
  • Cardiopatía reumática
  • Anomalías valvulares
  • Defectos congénitos
  • Presencia de una válvula protésica
• Edad > 60 años
• Uso de drogas por vía intravenosa (afecta más comúnmente a la válvula tricúspide)
• Dentición deficiente
• Dispositivos o catéteres implantados
• Inmunosupresión
• Antecedentes de endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis

Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa

• Factores predisponentes:
  • Anomalía o lesión del endocardio
  • Bacteriemia
• Endotelio dañado → depósito de plaquetas y fibrina → adhesión de microorganismos
• Proliferación e invasión de organismos → inflamación → desarrollo de la vegetación → destrucción de la válvula
• Liberación de émbolos sépticos → complicaciones embólicas y/o infección metastásica

Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis no infecciosa

• Lesión endotelial en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las valvas de la válvula debido a:
  • Trauma
  • Complejos inmunes circulantes
  • Citoquinas
  • Reacciones antígeno-anticuerpo
• Se produce la activación y el depósito de plaquetas (a menudo durante un estado de hipercoagulabilidad).
• El trombo está entrelazado con:
  • Fibrina
  • Complejos inmunitarios
  • Células mononucleares
• Las vegetaciones se desprenden fácilmente → complicaciones embólicas

Clasificación

La endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa puede clasificarse además en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum función de la evolución clínica, el tipo de válvula y la localización.

Según su curso clínico

Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa aguda:

• Aparición más repentina de los LOS Neisseria síntomas
• Progresa más rápidamente
• Vegetación de mayor tamaño
• Afecta más comúnmente a las válvulas normales
• Fatal si no se trata a tiempo
• La causa más común es el S. aureus S. aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Staphylococcus.

Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa subaguda ( endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis lenta):

• Inicio más gradual de los LOS Neisseria síntomas
• Progresa más lentamente (de semanas a meses)
• Vegetaciones más pequeñas
• Afecta más comúnmente a las válvulas congénitamente anormales o enfermas
• Los LOS Neisseria pacientes pueden sobrevivir durante meses sin tratamiento.
• La causa más común es S. viridans.

Según el tipo de válvula

Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis de válvula nativa:

• Representa el 78% de los LOS Neisseria casos
• Además, se subdivide en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Adquirida en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la comunidad (la más común)
  • Asociada a los LOS Neisseria cuidados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum salud
  • Consumo de drogas por vía intravenosa
• Se asocia más a menudo con:
  • Staphylococcus Staphylococcus Staphylococcus is a medically important genera of Gram-positive, aerobic cocci. These bacteria form clusters resembling grapes on culture plates. Staphylococci are ubiquitous for humans, and many strains compose the normal skin flora. Staphylococcus
  • Streptococcus Streptococcus Streptococcus is one of the two medically important genera of gram-positive cocci, the other being Staphylococcus. Streptococci are identified as different species on blood agar on the basis of their hemolytic pattern and sensitivity to optochin and bacitracin. There are many pathogenic species of streptococci, including S. pyogenes, S. agalactiae, S. pneumoniae, and the viridans streptococci. Streptococcus
  • Organismos HACEK

Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis de válvula protésica:

• Además, se subdivide en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Temprana:
    • < 60 días después de la colocación de la válvula
    • A menudo por contaminación durante la cirugía
    • Precaución con los LOS Neisseria organismos resistentes a los LOS Neisseria antimicrobianos.
  • Intermedia: 60–365 días después de la colocación de la válvula
  • Tardía:
    • > 1 año después de la colocación de la válvula
    • Suele implicar a organismos similares a la endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis de la válvula nativa
• Se asocia a un mayor riesgo de complicaciones y mortalidad

Según su ubicación

Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis del lado izquierdo:

• Válvula mitral
• Válvula aórtica

Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis del lado derecho (más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el uso de drogas intravenosas):

• Válvula tricúspide
• Válvula pulmonar

Presentación Clínica

La presentación y el curso dependen de la etiología, la localización de las vegetaciones y la gravedad.

Signos y síntomas generales

Los LOS Neisseria siguientes son más frecuentes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa que en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la no infecciosa:

• Fiebre (debe sospecharse una endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un paciente con fiebre de origen desconocido)
• Sudores nocturnos
• Fatiga
• Pérdida de apetito
• Pérdida de peso
• Mialgias y artralgias

Hallazgos cardíacos

• Soplo cardíaco nuevo o modificado:
  • Insuficiencia mitral
  • Insuficiencia tricuspídea
  • Insuficiencia aórtica
• Taquicardia
• Arritmia:
  • Potencialmente debido a la propagación de la infección y a la formación de un absceso miocárdico
  • Produce una alteración del sistema de conducción auriculoventricular → retraso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la conducción o bloqueo cardíaco

Hallazgos extracardíacos

Los LOS Neisseria siguientes son los LOS Neisseria posibles hallazgos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa

• Hemorragias en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum astilla:
  • Pequeñas áreas de coloración eritematosa bajo las uñas
  • Debido a microémbolos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria capilares
• Nodos de Osler:
  • Nódulos dolorosos eritematosos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria pulpejos de los LOS Neisseria dedos de las manos y de los LOS Neisseria pies
  • Debido a la deposición de inmunocomplejos y a la inflamación
• Las lesiones de Janeway:
  • Lesiones pequeñas, indoloras y eritematosas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las palmas de las manos o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las plantas de los LOS Neisseria pies
  • Debido a émbolos sépticos y microabscesos
• Manchas de Roth:
  • Manchas rojas con centros pálidos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el examen fundoscópico
  • Debido a las hemorragias de la retina Retina The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outermost layer is pigmented, whereas the inner nine layers are transparent. Eye: Anatomy
• Petequias
• Hemorragia conjuntival

Mnemotecnia

Los signos de endocarditis pueden recordarse con la mnemotecnia “FROM JANE” ( En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés):

• Fever (Fiebre)
• Roth spots (Manchas de Roth)
• Osler nodes (Nódulos de Osler)
• Murmur (Soplo)
• Janeway lesions (Lesiones de Janeway)
• Anemia ( Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types)
• Nail bed hemorrhage (Hemorragia del lecho ungueal)
• Emboli (Émbolos)

Embolización sistémica

La embolización sistémica puede ocurrir tanto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa como en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la no infecciosa. A menudo, un evento embólico es la única evidencia que presenta la endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis no infecciosa.

• Accidente isquémico transitorio o accidente cerebrovascular: nuevo déficit neurológico focal
• Tromboembolismo pulmonar:
  • Disnea
  • Dolor Dolor Inflammation torácico pleurítico
  • Tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome
  • Hemoptisis
• Infarto renal:
  • Dolor Dolor Inflammation de costado
  • Hematuria Hematuria Presence of blood in the urine. Renal Cell Carcinoma
• Embolia esplénica: Dolor Dolor Inflammation en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadrante superior izquierdo

Otras complicaciones

• Cardíaca:
  • Absceso perivalvular
  • Insuficiencia valvular
  • Rotura de la válvula
  • Insuficiencia cardíaca
  • Pericarditis Pericarditis Pericarditis is an inflammation of the pericardium, often with fluid accumulation. It can be caused by infection (often viral), myocardial infarction, drugs, malignancies, metabolic disorders, autoimmune disorders, or trauma. Acute, subacute, and chronic forms exist. Pericarditis → taponamiento cardíaco
• Renal:
  • Glomerulonefritis
  • Nefrotoxicidad inducida por antibióticos
• Infecciones metastásicas:
  • Absceso esplénico
  • Aneurisma micótico → hemorragia cerebral
  • Absceso cerebral o meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis
  • Artritis séptica
  • Osteomielitis
  • Absceso renal
  • Neumonía o absceso pulmonar
• Muerte: tasa de mortalidad de hasta el 40%.

Diagnóstico

Ecocardiograma

• Ecocardiograma transtorácico:
  • Se utiliza como herramienta de tamizaje inicial
  • Un estudio negativo no excluye el diagnóstico.
• Ecocardiograma transesofágico:
  • Más sensible, pero más invasivo
  • Debe realizarse si la ecocardiografía transtorácica es negativa y la sospecha de endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis es alta
• Recomendaciones:
  • Vegetaciones valvulares:
    • Tamaño
    • Movilidad
    • Calcificaciones
  • Complicaciones:
    • Insuficiencia valvular
    • Absceso
• No se puede determinar la causa de las vegetaciones (endocardiits infecciosa vs no infecciosa)

Estudios adicionales

Resultados de laboratorio:

• Los LOS Neisseria siguientes son inespecíficos, pero pueden ser una señal de endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa:
  • Hemocultivos:
    • Deben obtenerse 3 juegos de diferentes sitios.
    • Debe obtenerse antes de iniciar los LOS Neisseria antibióticos
    • Los LOS Neisseria cultivos negativos no descartan la endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa.
  • Serología:
    • Considerar la posibilidad de proseguir si los LOS Neisseria cultivos son negativos
    • Útil para los LOS Neisseria organismos fastidiosos
  • Hemograma
    • Leucocitosis con desplazamiento a la izquierda
    • Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types normocítica
  • Marcadores inflamatorios:
    • ↑ Velocidad de eritrosedimentación
    • ↑ PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR)
• Lo siguiente puede ser útil en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis no infecciosa:
  • Anticuerpos antinucleares
  • Anticoagulante lúpico
  • Anticuerpos antifosfolípidos

Imagenología:

• ECG ECG An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Electrocardiogram (ECG):
  • Generalmente normal a menos que haya extensión de la infección
  • Se debe realizar un trazo basal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todos los LOS Neisseria pacientes.
  • Posibles hallazgos:
    • Bloqueo cardíaco o disociación auriculoventricular
    • Bloqueo de rama
• Radiografía de tórax:
  • Puede descartar otras causas de los LOS Neisseria síntomas
  • Posibles hallazgos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis:
    • Embolia séptica a los LOS Neisseria pulmones
    • Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema pulmonar y cardiomegalia
• TC:
  • Puede utilizarse para evaluar los LOS Neisseria focos de infección metastásica
  • Puede ser útil si se sospecha de una neoplasia subyacente (para endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis no infecciosa)
• RM: se realiza si se sospecha de eventos embólicos cerebrales

Criterios diagnósticos de Duke

Los LOS Neisseria criterios diagnósticos de Duke son un conjunto de criterios clínicos que pueden ayudar al AL Amyloidosis diagnóstico de la endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa.

• Debe cumplir 1 de los LOS Neisseria siguientes requisitos para el diagnóstico definitivo de endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa:
  • 2 criterios mayores
  • 1 criterio mayor más 3 criterios menores
  • 5 criterios menores
• Criterios mayores:
  • Hemocultivos positivos (1 de los LOS Neisseria siguientes):
    • Organismo típico de la endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 2 hemocultivos distintos
    • Cultivos persistentemente positivos
    • Un solo cultivo positivo para Coxiella burnetii Coxiella burnetii A species of gram-negative bacteria that grows preferentially in the vacuoles of the host cell. It is the etiological agent of q fever. Coxiella/Q Fever o título de anticuerpos IgG IgG The major immunoglobulin isotype class in normal human serum. There are several isotype subclasses of igg, for example, igg1, igg2a, and igg2b. Hypersensitivity Pneumonitis de fase I >1:800
  • Hallazgos de afectación endocárdica (1 de los LOS Neisseria siguientes):
    • Por ecocardiograma
    • Nuevo soplo de insuficiencia
    • Actividad anormal alrededor de la válvula protésica mediante PET PET An imaging technique that combines a positron-emission tomography (PET) scanner and a ct X ray scanner. This establishes a precise anatomic localization in the same session. Nuclear Imaging/TC con [18F]-FDG o SPECT SPECT An imaging technique using a device which combines tomography, emission-computed, single-photon and tomography, x-ray computed in the same session. Nuclear Imaging/TC con leucocitos
    • Lesiones paravalvulares definitivas mediante TC cardíaca
• Criterios menores:
  • Fiebre > 38°C (100,4°F)
  • Factores de riesgo:
    • Consumo de drogas por vía intravenosa
    • Condición cardíaca predisponente
  • Hallazgos vasculares:
    • Hemorragia intracraneal
    • Infartos pulmonares
    • Eventos embólicos asintomáticos detectados por imagen
  • Hallazgos inmunológicos:
    • Nodos de Osler
    • Manchas de Roth
    • Glomerulonefritis
  • Hallazgos microbiológicos por cultivo que no cumplen los LOS Neisseria criterios principales

Tratamiento

Tratamiento médico de la endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis infecciosa

Es necesario iniciar rápidamente la administración de antibióticos por vía intravenosa si el paciente está gravemente enfermo.

• Consultas recomendadas:
  • Enfermedades infecciosas
  • Cardiología
  • Cirugía cardiotorácica
• Iniciar los LOS Neisseria antibióticos empíricos:
  • Válvula nativa:
    • Vancomicina
    • Ceftriaxona o cefepima
  • Válvula protésica:
    • Vancomicina
    • Gentamicina
    • Rifampin Rifampin A semisynthetic antibiotic produced from streptomyces mediterranei. It has a broad antibacterial spectrum, including activity against several forms of Mycobacterium. In susceptible organisms it inhibits dna-dependent RNA polymerase activity by forming a stable complex with the enzyme. It thus suppresses the initiation of RNA synthesis. Rifampin is bactericidal, and acts on both intracellular and extracellular organisms. Epiglottitis
• Adaptar los LOS Neisseria antibióticos o antifúngicos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum función de:
  • Patógeno identificado
  • Sensibilidades
• Repetir los LOS Neisseria hemocultivos cada 24 horas hasta que sean negativos.
• Duración de la terapia: 6 semanas

Tratamiento médico de la endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis no infecciosa

• Tratamiento del trastorno subyacente
• Anticoagulación (heparina no fraccionada o de bajo peso molecular)

Tratamiento quirúrgico

• La reparación o sustitución de la válvula está indicada para:
  • Insuficiencia cardíaca
  • Infección persistente
  • Eventos embólicos
  • Dehiscencia de la válvula protésica
  • Absceso perivalvular
  • Alteraciones de la conducción
• La extracción de dispositivo implantado (e.g., marcapasos) está indicada si:
  • Infección definitiva del cableado o del dispositivo
  • Sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock
  • Infección del bolsillo
  • Bacteriemia persistente
  • Bacteriemia por Staphylococcus Staphylococcus Staphylococcus is a medically important genera of Gram-positive, aerobic cocci. These bacteria form clusters resembling grapes on culture plates. Staphylococci are ubiquitous for humans, and many strains compose the normal skin flora. Staphylococcus

Prevención

• Antibióticos previos a los LOS Neisseria procedimientos:
  • Procedimientos de alto riesgo:
    • Procedimientos dentales que impliquen la manipulación de la encía o la mucosa
    • Procedimientos del tracto respiratorio que impliquen biopsia o manipulación de la mucosa
  • Profilaxis indicada para:
    • Válvulas protésicas
    • Cardiopatía congénita cianótica no reparada
    • Reparación de un defecto cardíaco congénito con material protésico
    • Episodio previo de endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis
    • Corazón trasplantado con valvulopatía
  • Opciones de antibióticos:
    • Amoxicilina (preferida)
    • Cefalexina
    • Clindamicina
• Tratamiento completo de las infecciones activas
• Higiene dental adecuada
• Evitar el abuso de drogas por vía intravenosa

Diagnóstico Diferencial

• Mixoma cardíaco: es un tumor Tumor Inflammation benigno y el más común de los LOS Neisseria tumores primarios del corazón del adulto. Los LOS Neisseria pacientes pueden desarrollar signos y síntomas de obstrucción valvular, tromboembolismo y arritmias. El diagnóstico se realiza mediante ecocardiografía, RM o TC cardíaca. La escisión quirúrgica completa es necesaria debido al AL Amyloidosis importante riesgo de embolización y de complicaciones cardiovasculares, incluida la muerte súbita.
• Trombosis de la válvula protésica: una anticoagulación insuficiente tras la implantación de una válvula protésica puede provocar la trombosis de la válvula, lo que pone al AL Amyloidosis paciente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum riesgo de tromboembolismo y de estenosis o insuficiencia valvular, lo que conduce a la insuficiencia cardíaca. El diagnóstico se realiza a partir de los LOS Neisseria antecedentes y la ecocardiografía. El tratamiento varía, pero puede incluir una terapia trombolítica, una anticoagulación adecuada y una posible cirugía cardíaca.
• Tromboembolismo pulmonar: obstrucción de las arterias pulmonares, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mayoría de los LOS Neisseria casos debido a la migración del trombo desde el sistema venoso profundo. Los LOS Neisseria signos y síntomas incluyen dolor Dolor Inflammation torácico pleurítico, disnea, taquipnea y taquicardia. Los LOS Neisseria casos severos pueden dar como resultado inestabilidad hemodinámica o paro cardíaco. Una TC de tórax con angiografía es el método principal de diagnóstico. El tratamiento incluye oxigenación, anticoagulación y terapia trombolítica para pacientes inestables.
• Miocarditis: inflamación del músculo cardíaco que puede ser de etiología infecciosa o no infecciosa. La presentación varía, pero puede incluir signos y síntomas de insuficiencia cardíaca y shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock cardiogénico. El ecocardiograma puede mostrar una disfunción sistólica global, la resonancia magnética cardíaca mostrará edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema y la biopsia endomiocárdica puede dar un diagnóstico definitivo. El tratamiento se centra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la insuficiencia cardíaca y la causa subyacente.
• Pericarditis Pericarditis Pericarditis is an inflammation of the pericardium, often with fluid accumulation. It can be caused by infection (often viral), myocardial infarction, drugs, malignancies, metabolic disorders, autoimmune disorders, or trauma. Acute, subacute, and chronic forms exist. Pericarditis: inflamación del revestimiento exterior del corazón como consecuencia de una infección, una enfermedad autoinmune, una radiación, una intervención quirúrgica o un infarto de miocardio. La pericarditis Pericarditis Pericarditis is an inflammation of the pericardium, often with fluid accumulation. It can be caused by infection (often viral), myocardial infarction, drugs, malignancies, metabolic disorders, autoimmune disorders, or trauma. Acute, subacute, and chronic forms exist. Pericarditis se presenta clínicamente con fiebre, dolor Dolor Inflammation torácico pleurítico que aumenta al AL Amyloidosis acostarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum posición supina y un roce pericárdico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la auscultación. Un ECG ECG An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Electrocardiogram (ECG) con elevación difusa del segmento ST y una ecocardiograma que muestre un derrame pericárdico pueden confirmar el diagnóstico. El tratamiento es de soporte.