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INFECTIVE ENDOCARDITIS : CAUSES; SIGNS AND MANAGEMENT
INFECTIVE ENDOCARDITIS
Microbial infection of mural endocardium , or valves or
lining of blood vessels
It is fatal if left untreated
TYPES
Acute
Caused by micro organism of high virulence
Involve normal or damaged heart valves
Rapidly destructive
Fatal within 6 weeks if left untreated
Valve destruction leading to mitral or aortic regurgitation is
common
Eg : staphylococcus aureus ; streptococcus ; pneumonia
Subacute
Caused by indigenous micro organism of low virulence
Involves on damaged heart valves
Produces systemic manifestations by bacteraemia , toxaemia,
and immune complex formation
Valve destruction is uncommon
Vegetative formation is common hence embolism is frequent
Eg : streptococci ; gram negative bacilli
PATHOLOGY
Bacteria in the circulation are deposited on the endocardium
at sites of high flow rate such as surface of right ventricle opposite of VSD
and in areas of turbulence in valvular heart disease
Alteration in blood flow leads to sterile vegetation
consisting platelets and fibrin
Endocarditis is initiated by transient bacteraemia
Endocarditis commonly involve left than right side of heart
CLINICAL FEATURES
Fever
Nausea
Anorexia
Weight loss
Night sweat
Tachycardia
Varying cardiac murmer
Loss of peripheral pulse
Weakness
Clubbing of finger
INVESTIGATION
Blood test: ESR and CRP may be elevated
Urine examination: mild proteinuria or haematuria if kidney
is affected
Serum complement level (C3): low due to immune complex
formation
DIAGNOSIS
Duke criteria
MANAGEMENT
Penicillin G (1.2G I.V): 4-6 hour interval
Gentamicin (1 mg /kg I.V):
8 hour interval
Vancomycin(15 mg/kg I.V): in staphylococcal endocarditis
