Endocarditis
Risk Factors
- IVDA
- Most significant risk factor for right-sided disease
- Prosthetic heart valve
- Structural heart disease
- Hemodialysis
Work-Up
- History
- Recent source of bacteremia?
- Indwelling catheters, IVDA
- Physical Exam
- Cardiac, fundi, conjunctivae, skin, digits,
- Labs
- Blood Cx
- All patients with S. aureus bacteremia should be evaluated for IE
- CBC
- Staphylococcal endocarditis: Leukocytosis +/- thrombocytopenia
- Subacute endocarditis: WBC may be normal or elevated
- UA
- C/w glomerulonephritis
- ECG
- Evidence of ischemia, heart block
- CXR
- Septic pulmonary emboli
- TTE
- Low Sn, high Sp
Diagnosis
- Duke Criteria
- 2 major criteria OR
- 1 major and 3 minor criteria OR
- 5 minor criteria
- Major Criteria
- Positive blood culture for infective endocarditis
- S. aureus, S. viridans, S. bovis, Enterococci, HACEK
- Evidence of endocardial involvement
- TEE + or new valvular regurgitation
- Minor Criteria
- Predisposition - predisposing heart condition or IVDA
- Fever - 38.0°C (100.4°F)
- Vascular phenomena
- Arterial emboli, pulmonary infarcts, mycotic aneurysm, ICH, conjunctival hemorrhage, Janeway lesions
- Immunologic phenomena - glomerulonephritis, Osler's nodes, Roth spots, rheumatoid factor
- Microbiologic evidence - positive blood culture but not meeting major criterion as noted previously
- Echo findings: consistent with IE but do not meet a major criterion as noted above
==Treatment==
- Antibiotics
- Only bactericidal agents are effective in treating endocarditis
- Vancomycin
==Complications==
- Cardiac
- Heart Failure
- Most common cause of death due to IE
- Perivalvular Abscess
- Embolic
- CVA
- Blindness
- Painful, ischemic extremities
- Unusual pain sydromes (due to splenic or renal infarction)
- Hypoxia
- Paralysis
- MI
- Neurologic
- Embolic stroke
- Acute encephalopathy
- Meningoencephalitis
- Purulent or aseptic meningitis
- Cerebral hemorrhage
- Seizure
- Renal
- Infarction
- Glomerulonephritis
- Musculoskeletal
- Vertebral osteomyelitis
Source
UpToDate