Endocarditis pathophysiology: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(3 intermediate revisions by the same user not shown)
Line 11: Line 11:


==Overview==
==Overview==
The pathogenesis of infective endocarditis includes valvular damage, altered and turbulent flow, bacteremia, and lack of blood supply to the [[valve]]s. Damaged endothelium becomes a site for attachment of infectious agents in infectious endocarditis.  Nonbacterial thrombotic endocarditis is related to hypercoaguable states such as [[pregnancy]] or systemic bacterial [[infection]]. The characteristic lesion of endocarditis is a vegetation.  Vegetations are composed of [[fibrin]], inflammatory cells, [[platelets]], and microorganisms.
The pathogenesis of infective endocarditis includes valvular damage, altered and turbulent flow, bacteremia, and lack of blood supply to the [[valve]]s. Damaged endothelium becomes a site for attachment of infectious agents in infectious endocarditis.  Nonbacterial thrombotic endocarditis is related to hypercoagulable states such as [[pregnancy]] or systemic bacterial [[infection]]. The characteristic lesion of endocarditis is vegetation.  Vegetations are composed of [[fibrin]], inflammatory cells, [[platelets]], and microorganisms.


==Pathophysiology==
==Pathophysiology==
Line 17: Line 17:
====Infective Endocarditis====
====Infective Endocarditis====


* The pathogenesis of infective endocarditis includes:<ref name="abc"> Infective endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Infective_endocarditis#Pathogenesis Accessed on September 21, 2015</ref><ref name="endo"> Endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Endocarditis Accessed on September 21, 2015</ref>
* The pathogenesis of infective endocarditis includes:
 
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
|valign=top|
|valign=top|
Line 80: Line 81:
* Selectin-E c.-19 GT
* Selectin-E c.-19 GT


Genes involved in the pathogenesis of nonbacterial thrombotic endocarditis include:<ref name="pmid21560828">{{cite journal |vauthors=Durante-Mangoni E, Iossa D, Nappi F, Utili R |title=Inherited hyper-homocysteinemia as a cause of nonbacterial thrombotic endocarditis |journal=J. Heart Valve Dis. |volume=20 |issue=2 |pages=232–3 |date=March 2011 |pmid=21560828 |doi= |url=}}</ref>
Genes involved in the pathogenesis of nonbacterial thrombotic [[endocarditis]] include:<ref name="pmid21560828">{{cite journal |vauthors=Durante-Mangoni E, Iossa D, Nappi F, Utili R |title=Inherited hyper-homocysteinemia as a cause of nonbacterial thrombotic endocarditis |journal=J. Heart Valve Dis. |volume=20 |issue=2 |pages=232–3 |date=March 2011 |pmid=21560828 |doi= |url=}}</ref>


* Homozygous for the C677T mutation of the [[Methylenetetrahydrofolate-tRNA-(uracil-5-)-methyltransferase|methylenetetrahydrofolate]] reductase gene which leads to [[Hyperhomocysteinemia|hyper-homocysteinemia]].
* Homozygous for the C677T mutation of the [[Methylenetetrahydrofolate-tRNA-(uracil-5-)-methyltransferase|methylenetetrahydrofolate]] reductase gene which leads to [[hyperhomocysteinemia]].
*  
*  


== Associated Conditions ==
== Associated Conditions ==
Conditions associated with endocarditis include:
Conditions associated with [[endocarditis]] include:


*[[Prosthetic heart valve]]s<ref name="pmid3272238">{{cite journal |vauthors=Arvay A, Lengyel M |title=Incidence and risk factors of prosthetic valve endocarditis |journal=Eur J Cardiothorac Surg |volume=2 |issue=5 |pages=340–6 |date=1988 |pmid=3272238 |doi= |url=}}</ref>
*[[Prosthetic heart valve]]s<ref name="pmid3272238">{{cite journal |vauthors=Arvay A, Lengyel M |title=Incidence and risk factors of prosthetic valve endocarditis |journal=Eur J Cardiothorac Surg |volume=2 |issue=5 |pages=340–6 |date=1988 |pmid=3272238 |doi= |url=}}</ref>
Line 125: Line 126:


* Vegetation:  
* Vegetation:  
** Vegetations are composed of fibrin, inflammatory cells, platelets, and microorganisms.<ref name="pmid11794152">{{cite journal| author=Mylonakis E, Calderwood SB| title=Infective endocarditis in adults. | journal=N Engl J Med | year= 2001 | volume= 345 | issue= 18 | pages= 1318-30 | pmid=11794152 | doi=10.1056/NEJMra010082 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11794152  }}</ref> <ref> Infective Endocarditis. Libre Pathology (2015). URL=http://librepathology.org/wiki/index.php/Infective_endocarditis Accessed on September 21, 2015</ref>
** Vegetations are composed of fibrin, inflammatory cells, platelets, and microorganisms.<ref name="pmid11794152">{{cite journal| author=Mylonakis E, Calderwood SB| title=Infective endocarditis in adults. | journal=N Engl J Med | year= 2001 | volume= 345 | issue= 18 | pages= 1318-30 | pmid=11794152 | doi=10.1056/NEJMra010082 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11794152  }}</ref>  


{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
Line 144: Line 145:
|}
|}


[http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]  
[http://www.peir.net Image courtesy of Professor Peter Anderson DVM Ph.D. and published with permission © PEIR, the University of Alabama at Birmingham, Department of Pathology]  


<div align="left"><gallery heights="150" widths="150">
<div align="left"><gallery heights="150" widths="150">
Image:Breast intraductal papilloma metastasis.jpg|Heart; Breast intraductal papilloma metastasis. Thrombotic Nonbacterial Endocarditis (Infected): Gross mitral valve natural color vegetations well illustrated these were secondarily infected with staphylococcus case of 8 year survival breast intraductal papillary adenocarcinoma with extensive metastases. Aortic valve also involved.
Image: Breast intraductal papilloma metastasis.jpg|Heart; Breast intraductal papilloma metastasis. Thrombotic Nonbacterial Endocarditis (Infected): Gross mitral valve natural color vegetations well-illustrated these were secondarily infected with staphylococcus case of 8-year survival breast intraductal papillary adenocarcinoma with extensive metastases. Aortic valve also involved.
Image:Papillar intraductal carcinoma metastasis to heart.JPG|Nonbacterial Thrombotic Endocarditis Infected: Micro low mag H&E fibrin vegetation with masses of staphylococci and inflammatory cells in valve secondarily infected case 8 year survival breast papillary intraductal adenocarcinoma with extensive metastases gross is aortic valve lesions.  
Image: Papillar intraductal carcinoma metastasis to heart.JPG|Nonbacterial Thrombotic Endocarditis Infected: Micro low mag H&E fibrin vegetation with masses of staphylococci and inflammatory cells in valve secondarily infected case 8-year survival breast papillary intraductal adenocarcinoma with extensive metastases gross is aortic valve lesions.  
</gallery>
</gallery>
</div>
</div>

Latest revision as of 02:24, 6 March 2020

https://https://www.youtube.com/watch?v=kW-85yk0ErQ%7C350}}

Endocarditis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Infective Endocarditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications & Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

Diagnosis and Follow-up

Medical Therapy

Intervention

Case Studies

Case #1

Endocarditis pathophysiology On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Endocarditis pathophysiology

CDC onEndocarditis pathophysiology

Endocarditis pathophysiology in the news

Blogs on Endocarditis pathophysiology

to Hospitals Treating Endocarditis pathophysiology

Risk calculators and risk factors for Endocarditis pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]

Overview

The pathogenesis of infective endocarditis includes valvular damage, altered and turbulent flow, bacteremia, and lack of blood supply to the valves. Damaged endothelium becomes a site for attachment of infectious agents in infectious endocarditis. Nonbacterial thrombotic endocarditis is related to hypercoagulable states such as pregnancy or systemic bacterial infection. The characteristic lesion of endocarditis is vegetation. Vegetations are composed of fibrin, inflammatory cells, platelets, and microorganisms.

Pathophysiology

Pathogenesis

Infective Endocarditis

  • The pathogenesis of infective endocarditis includes:
Pathogenic Factors Mechanism
Valvular Damage
  • Altered and turbulent flow
  • Catheters, electrodes, and other intracardiac devices
  • Solid particles from repeated intravenous injections
  • Chronic inflammation
Bacteremia
Lack of blood supply to valves
  • Blunted immune response
  • Therapeutic drugs have difficulty reaching infected valves

Nonbacterial Thrombotic Endocarditis

  • The exact pathogenesis of nonbacterial thrombotic endocarditis is not completely understood.
  • Nonbacterial thrombotic endocarditis (NBTE), also called marantic endocarditis is most commonly found on previously undamaged valves.
  • The vegetations in nonbacterial thrombotic endocarditis are sterile and small.
  • The vegetations mostly aggregate at the edges of the valve or the cusps.
  • We can divide the pathogenesis pathway of nonbacterial endocarditis into to phase:
    • Initiating phase
      • Immune complexes:[1][2]
        • Circulating immune complexes and complement deposition can initiate the process.
        • The example for this initiating factor in libman sacks endocarditis in lupus patients.
      • Hypoxia:[3][4]
        • Some studies demonstrated that hypoxia may lead to tissue factor activation.
        • Higher tissue factor level has an association with higher rate of endocarditis.
        • Other studies implies that the rate of endocarditis is higher in smokers and patients with chronic lung disease and possibly hypoxia.
      • Hypercoagulability:[5][6]
        • There is an association between hypercoagulable state and clotting factor abnormalities with initiation of nonbacterial thrombotic endocarditis.
      • Carcinomatosis:[7]
        • The association between cancer and nonbacterial thrombotic endocarditis is well established.
        • In most of the cases of cancer related endocarditis we have abnormal activity of tissue factor.
        • Tissue factor may be secreted from promyelocytic leukaemia cells.
        • Tissue factor may be expressed on the surface of adenocarcinoma cells which leads to increased expression of tissue factor by endothelial cells.
    • Verrucae formation

Genetics

Genes involved in the pathogenesis of infective endocarditis include:[8]

  • Interleukin-6 c.471+870G>A
  • Interleukin-1b c.315C>T
  • Selectin-E c.-19 GT

Genes involved in the pathogenesis of nonbacterial thrombotic endocarditis include:[9]

Associated Conditions

Conditions associated with endocarditis include:

Gross Pathology

On gross pathology, characteristic findings of endocarditis are:

Endocarditis Subtype Features on Gross Pathology
Infective Endocarditis
  • Left-sided valve involvement (mitral, aortic) more common generally
  • Right-sided valve involvement (pulmonic, tricuspid valve) more common in intravenous drug abusers
  • Valvular vegetations
  • Valvular destruction
Nonbacterial Thrombotic Endocarditis
  • Round non-destructive vegetations, usually at the line of closure

Microscopic Pathology

On microscopic histopathological, characteristic findings of endocarditis are:

  • Vegetation:
    • Vegetations are composed of fibrin, inflammatory cells, platelets, and microorganisms.[25]
Endocarditis Subtype Features on Histopathological Microscopic Analysis
Infective Endocarditis
  • Inflammatory infiltrate
  • Abundant neutrophils
  • Plasma cells may be present in subacute endocarditis
  • Microorganisms present
Nonbacterial Thrombotic Endocarditis
  • Vegetations without inflammation and microorganisms

Image courtesy of Professor Peter Anderson DVM Ph.D. and published with permission © PEIR, the University of Alabama at Birmingham, Department of Pathology

  • Heart; Breast intraductal papilloma metastasis. Thrombotic Nonbacterial Endocarditis (Infected): Gross mitral valve natural color vegetations well-illustrated these were secondarily infected with staphylococcus case of 8-year survival breast intraductal papillary adenocarcinoma with extensive metastases. Aortic valve also involved.

    Heart; Breast intraductal papilloma metastasis. Thrombotic Nonbacterial Endocarditis (Infected): Gross mitral valve natural color vegetations well-illustrated these were secondarily infected with staphylococcus case of 8-year survival breast intraductal papillary adenocarcinoma with extensive metastases. Aortic valve also involved.

  • Nonbacterial Thrombotic Endocarditis Infected: Micro low mag H&E fibrin vegetation with masses of staphylococci and inflammatory cells in valve secondarily infected case 8-year survival breast papillary intraductal adenocarcinoma with extensive metastases gross is aortic valve lesions.

    Nonbacterial Thrombotic Endocarditis Infected: Micro low mag H&E fibrin vegetation with masses of staphylococci and inflammatory cells in valve secondarily infected case 8-year survival breast papillary intraductal adenocarcinoma with extensive metastases gross is aortic valve lesions.

Videos

{{#ev:youtube|gk7cpP2ymOs}} {{#ev:youtube|BiNulEFh6rU}}

References

  1. ↑ Ford PM, Ford SE, Lillicrap DP (April 1988). "Association of lupus anticoagulant with severe valvular heart disease in systemic lupus erythematosus". J. Rheumatol. 15 (4): 597–600. PMID 3135393.
  2. ↑ Williams, Ralph (1980). Immune complexes in clinical and experimental medicine. Cambridge, Mass: Harvard University Press. ISBN 978-0674444386.
  3. ↑ Nakanishi K, Tajima F, Nakata Y, Osada H, Ogata K, Kawai T, Torikata C, Suga T, Takishima K, Aurues T, Ikeda T (October 1998). "Tissue factor is associated with the nonbacterial thrombotic endocarditis induced by a hypobaric hypoxic environment in rats". Virchows Arch. 433 (4): 375–9. doi:10.1007/s004280050262. PMID 9808440.
  4. ↑ Truskinovsky AM, Hutchins GM (April 2001). "Association between nonbacterial thrombotic endocarditis and hypoxigenic pulmonary diseases". Virchows Arch. 438 (4): 357–61. doi:10.1007/s004280000372. PMID 11355169.
  5. ↑ MACDONALD RA, ROBBINS SL (February 1957). "The significance of nonbacterial thrombotic endocarditis: an autopsy and clinical study of 78 cases". Ann. Intern. Med. 46 (2): 255–73. doi:10.7326/0003-4819-46-2-255. PMID 13403513.
  6. ↑ Sack GH, Levin J, Bell WR (January 1977). "Trousseau's syndrome and other manifestations of chronic disseminated coagulopathy in patients with neoplasms: clinical, pathophysiologic, and therapeutic features". Medicine (Baltimore). 56 (1): 1–37. PMID 834136.
  7. ↑ Gralnick HR, Abrell E (January 1973). "Studies of the procoagulant and fibrinolytic activity of promyelocytes in acute promyelocytic leukaemia". Br. J. Haematol. 24 (1): 89–99. doi:10.1111/j.1365-2141.1973.tb05730.x. PMID 4577065.
  8. ↑ Weinstock M, Grimm I, Dreier J, Knabbe C, Vollmer T (2014). "Genetic variants in genes of the inflammatory response in association with infective endocarditis". PLoS ONE. 9 (10): e110151. doi:10.1371/journal.pone.0110151. PMC 4192365. PMID 25299518.
  9. ↑ Durante-Mangoni E, Iossa D, Nappi F, Utili R (March 2011). "Inherited hyper-homocysteinemia as a cause of nonbacterial thrombotic endocarditis". J. Heart Valve Dis. 20 (2): 232–3. PMID 21560828.
  10. ↑ Arvay A, Lengyel M (1988). "Incidence and risk factors of prosthetic valve endocarditis". Eur J Cardiothorac Surg. 2 (5): 340–6. PMID 3272238.
  11. ↑ Mylonakis E, Calderwood SB (2001). "Infective endocarditis in adults". N Engl J Med. 345 (18): 1318–30. doi:10.1056/NEJMra010082. PMID 11794152.
  12. ↑ Corrigall, Denton; Bolen, James; Hancock, E.William; Popp, Richard L. (1977). "Mitral valve prolapse and infective endocarditis". The American Journal of Medicine. 63 (2): 215–222. doi:10.1016/0002-9343(77)90235-2. ISSN 0002-9343.
  13. ↑ Sousa, C.; Botelho, C.; Rodrigues, D.; Azeredo, J.; Oliveira, R. (2012). "Infective endocarditis in intravenous drug abusers: an update". European Journal of Clinical Microbiology & Infectious Diseases. 31 (11): 2905–2910. doi:10.1007/s10096-012-1675-x. ISSN 0934-9723.
  14. ↑ Sohail, Muhammad R.; Uslan, Daniel Z.; Khan, Akbar H.; Friedman, Paul A.; Hayes, David L.; Wilson, Walter R.; Steckelberg, James M.; Jenkins, Sarah M.; Baddour, Larry M. (2008). "Infective Endocarditis Complicating Permanent Pacemaker and Implantable Cardioverter-Defibrillator Infection". Mayo Clinic Proceedings. 83 (1): 46–53. doi:10.4065/83.1.46. ISSN 0025-6196.
  15. ↑ Mccarthy, James T.; Steckelberg, James M. (2000). "Infective Endocarditis in Patients Receiving Long-term Hemodialysis". Mayo Clinic Proceedings. 75 (10): 1008–1014. doi:10.4065/75.10.1008. ISSN 0025-6196.
  16. ↑ Knirsch, Walter; Nadal, David (2011). "Infective endocarditis in congenital heart disease". European Journal of Pediatrics. 170 (9): 1111–1127. doi:10.1007/s00431-011-1520-8. ISSN 0340-6199.
  17. ↑ Strom BL, Abrutyn E, Berlin JA, Kinman JL, Feldman RS, Stolley PD, Levison ME, Korzeniowski OM, Kaye D (November 1998). "Dental and cardiac risk factors for infective endocarditis. A population-based, case-control study". Ann. Intern. Med. 129 (10): 761–9. doi:10.7326/0003-4819-129-10-199811150-00002. PMID 9841581.
  18. ↑ Lin CJ, Chua S, Chung SY, Hang CL, Tsai TH (June 2019). "Diabetes Mellitus: An Independent Risk Factor of In-Hospital Mortality in Patients with Infective Endocarditis in a New Era of Clinical Practice". Int J Environ Res Public Health. 16 (12). doi:10.3390/ijerph16122248. PMC 6617149 Check |pmc= value (help). PMID 31242695.
  19. ↑ Chirillo F, Bacchion F, Pedrocco A, Scotton P, De Leo A, Rocco F, Valfrè C, Olivari Z (May 2010). "Infective endocarditis in patients with diabetes mellitus". J. Heart Valve Dis. 19 (3): 312–20. PMID 20583393.
  20. ↑ Lazarovitch, T.; Shango, M.; Levine, M.; Brusovansky, R.; Akins, R.; Hayakawa, K.; Lephart, P. R.; Sobel, J. D.; Kaye, K. S.; Marchaim, D. (2012). "The relationship between the new taxonomy of Streptococcus bovis and its clonality to colon cancer, endocarditis, and biliary disease". Infection. 41 (2): 329–337. doi:10.1007/s15010-012-0314-x. ISSN 0300-8126.
  21. ↑ "THE SIGNIFICANCE OF NONBACTERIAL THROMBOTIC ENDOCARDITIS: AN AUTOPSY AND CLINICAL STUDY OF 78 CASES". Annals of Internal Medicine. 46 (2): 255. 1957. doi:10.7326/0003-4819-46-2-255. ISSN 0003-4819.
  22. ↑ Horwitz, Charles A.; Ward, Patrick C.J. (1971). "Disseminated intravascular coagulation, nonbacterial thrombotic endocarditis and adult pulmonary hyaline membranes-an interrelated triad?". The American Journal of Medicine. 51 (2): 272–280. doi:10.1016/0002-9343(71)90245-2. ISSN 0002-9343.
  23. ↑ Min, Kyung-Whan; Gyorkey, Ferene; Sato, Clifford (1980). "Mucin-producing adenocarcinomas and nonbacterial thrombotic endocarditis. Pathogenetic role of tumor mucin". Cancer. 45 (9): 2374–2382. doi:10.1002/1097-0142(19800501)45:9<2374::AID-CNCR2820450923>3.0.CO;2-J. ISSN 0008-543X.
  24. ↑ Moyssakis, Ioannis; Tektonidou, Maria G.; Vasilliou, Vassilios A.; Samarkos, Michael; Votteas, Vassilios; Moutsopoulos, Haralampos M. (2007). "Libman-Sacks Endocarditis in Systemic Lupus Erythematosus: Prevalence, Associations, and Evolution". The American Journal of Medicine. 120 (7): 636–642. doi:10.1016/j.amjmed.2007.01.024. ISSN 0002-9343.
  25. ↑ Mylonakis E, Calderwood SB (2001). "Infective endocarditis in adults". N Engl J Med. 345 (18): 1318–30. doi:10.1056/NEJMra010082. PMID 11794152.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Endocarditis_pathophysiology&oldid=1601465"