Endocarditis - Wikipedia, the free encyclopedia

7/17/15, 20:59

Endocarditis
From Wikipedia, the free encyclopedia

Endocarditis is an inflammation of the

inner layer of the heart, the
endocardium. It usually involves the
heart valves. Other structures that may
be involved include the interventricular
septum, the chordae tendineae, the
mural endocardium, or the surfaces of
intracardiac devices. Endocarditis is
characterized by lesions, known as
vegetations, which is a mass of
platelets, fibrin, microcolonies of
microorganisms, and scant
inflammatory cells.[1] In the subacute
form of infective endocarditis, the
vegetation may also include a center of
granulomatous tissue, which may

Endocarditis

Bartonella henselae bacilli in cardiac valve of a patient with blood culturenegative endocarditis. The bacilli appear as black granulations.
Classification and external resources
Specialty

Cardiology, infectious disease

ICD-10

I33
(http://apps.who.int/classifications/icd10/browse/2015/en#/I33)

ICD-9-CM

421 (http://www.icd9data.com/getICD9Code.ashx?icd9=421)

fibrose or calcify.[2]

There are several ways to classify

DiseasesDB 4224 (http://www.diseasesdatabase.com/ddb4224.htm)
endocarditis. The simplest
classification is based on cause: either
MedlinePlus 001098
infective or non-infective, depending on
(http://www.nlm.nih.gov/medlineplus/ency/article/001098.htm)
whether a microorganism is the source
eMedicine emerg/164 (http://www.emedicine.com/emerg/topic164.htm)
of the inflammation or not. Regardless,
med/671 (http://www.emedicine.com/med/topic671.htm#)
the diagnosis of endocarditis is based
ped/2511 (http://www.emedicine.com/ped/topic2511.htm#)
on clinical features, investigations such
as an echocardiogram, and blood
Patient UK Endocarditis (http://patient.info/doctor/infective-endocarditiscultures demonstrating the presence of
pro)
endocarditis-causing microorganisms.
MeSH
D004696 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?
Signs and symptoms include: fever,
field=uid&term=D004696)
chills, sweating, malaise, weakness,
anorexia, weight loss, splenomegaly,
flu like feeling, cardiac murmur, heart failure, patechia of anterior trunk, Janeway's lesions, etc.

Contents
1 Cause
1.1 Infective
1.2 Non-infective
2 Diagnostics
3 References
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4 External links

Cause
Infective
Since the valves of the heart do not receive any dedicated blood supply, defensive immune mechanisms (such as
white blood cells) cannot directly reach the valves via the bloodstream. If an organism (such as bacteria)
attaches to a valve surface and forms a vegetation, the host immune response is blunted. The lack of blood
supply to the valves also has implications on treatment, since drugs also have difficulty reaching the infected
valve.
Normally, blood flows smoothly past these valves. If they have been damaged (from rheumatic fever, for
example) the risk of bacteria attachment is increased.[2]
Rheumatic fever is common worldwide and responsible for many cases of damaged heart valves. Chronic
rheumatic heart disease is characterized by repeated inflammation with fibrinous resolution. The cardinal
anatomic changes of the valve include leaflet thickening, commissural fusion, and shortening and thickening of
the tendinous cords.[3] The recurrence of rheumatic fever is relatively common in the absence of maintenance of
low dose antibiotics, especially during the first three to five years after the first episode. Heart complications
may be long-term and severe, particularly if valves are involved. While rheumatic fever since the advent of
routine penicillin administration for Strep throat has become less common in developed countries, in the older
generation and in much of the less-developed world, valvular disease (including mitral valve prolapse,
reinfection in the form of valvular endocarditis, and valve rupture) from undertreated rheumatic fever continues
to be a problem.[4]
In an Indian hospital between 2004 and 2005, 4 of 24 endocarditis patients failed to demonstrate classic
vegetation. All had rheumatic heart disease and presented with prolonged fever. All had severe eccentric mitral
regurgitation. (One had severe aortic regurgitation also.) One had flail posterior mitral leaflet.[5]

Non-infective
Nonbacterial thrombotic endocarditis (NBTE), also called marantic endocarditis is most commonly found on
previously undamaged valves.[2] As opposed to infective endocarditis, the vegetations in NBTE are small,
sterile, and tend to aggregate along the edges of the valve or the cusps.[2] Also unlike infective endocarditis,
NBTE does not cause an inflammation response from the body.[2] NBTE usually occurs during a
hypercoagulable state such as system wide bacterial infection, or pregnancy, though it is also sometimes seen in
patients with venous catheters.[2] NBTE may also occur in patients with cancers, particularly mucinous
adenocarcinoma[2] where Trousseau syndrome can be encountered. Typically NBTE does not cause many
problems on its own, but parts of the vegetations may break off and embolize to the heart or brain, or they may
serve as a focus where bacteria can lodge, thus causing infective endocarditis.[2]

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Another form of sterile endocarditis, is termed Libman-Sacks endocarditis; this form occurs more often in
patients with lupus erythematosus and is thought to be due to the deposition of immune complexes.[2] Like
NBTE, Libman-Sacks endocarditis involves small vegetations, while infective endocarditis is composed of large
vegetations.[2] These immune complexes precipitate an inflammation reaction, which helps to differentiate it
from NBTE. Also unlike NBTE, Libman-Sacks endocarditis does not seem to have a preferred location of
deposition and may form on the undersurfaces of the valves or even on the endocardium.[2]

Diagnostics
Examination of suspected infective endocarditis includes a detailed examination of the patient, complete history
taking, and especially careful cardiac auscultation, various blood tests, ECG, cardiac ultrasound
(echocardiography). In the overall analysis of blood revealed the typical signs of inflammation (increased
erythrocyte sedimentation rate, leukocytosis). It is also necessary to sow twice venous blood in order to identify
the specific pathogen (this requires two samples of blood). Negative blood cultures, however, does not exclude
the diagnosis of infective endocarditis. The decisive role played by echocardiography in the diagnosis (through
the anterior chest wall or transesophageal), with which you can reliably establish the presence of microbial
vegetation, the degree of valvular and violations of the pumping function of the heart.[6]

References
1. Kasper DL, Braunwald E, Fauci AS, Hauser S, Longo DL, Jameson JL (May 2005). Harrison's Principles of Internal
Medicine. McGraw-Hill. pp. 73140. ISBN 0-07-139140-1. OCLC 54501403 56437106 56801936 56967424
(https://www.worldcat.org/oclc/54501403+56437106+56801936+56967424).
2. Mitchell RS, Kumar V, Robbins SL, Abbas AK, Fausto N (2007). Robbins Basic Pathology (8th ed.). Saunders/Elsevier.
pp. 4068. ISBN 1-4160-2973-7.
3. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran
pathologic basis of disease (http://www.robbinspathology.com/). St. Louis, Mo: Elsevier Saunders. ISBN 0-7216-0187-1.
4. NLM/NIH: Medline Plus Medical Encyclopedia: Rheumatic fever
(http://www.nlm.nih.gov/medlineplus/ency/article/003940.htm)
5. S Venkatesan et al. (SepOct 2007). "Can we diagnose Infective endocarditis without vegetation ?"
(https://drsvenkatesan.wordpress.com/2009/04/10/can-we-diagnose-infective-endocarditis-without-vegetation/). Indian
Heart Journal 59 (5).
6. http://medusanews.com/diseases-and-conditions/cardiology/endocarditis.html

External links
Endocarditis
(https://www.dmoz.org/Health/Conditions_and_Diseases/Cardiovascular_Disorders/Heart_Disease/Endocarditis
/) at DMOZ
Retrieved from "https://en.wikipedia.org/w/index.php?title=Endocarditis&oldid=670118264"
Categories: Valvular heart disease Inflammations Rodent-carried diseases

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