Endocarditis laboratory findings: Difference between revisions

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__NOTOC__
{{Endocarditis}}
{{Endocarditis}}


{{CMG}}; '''Associate Editors-in-Chief:''' {{CZ}}
{{CMG}}; {{AE}} {{CZ}}


== Overivew==  
== Overivew==  
In endocarditis, the [[white blood cell count]] and [[erythrocyte sedimentation rate]] are elevated.  The [[rheumatoid factor]] is elevated in half of patients.  The [[BUN]] and [[Cr]] may be elevated in the presence of [[glomerulonephritis]].  The EKG can show conduction abnormalities in the presence of a [[myocardial abscess]].  The EKG can show [[ST elevation]] in the presence of embolization of a vegetation or clot down the coronary artery.
Laboratory findings consistent with the diagnosis of endocarditis include elevated [[white blood cell count]], [[erythrocyte sedimentation rate]], [[rheumatoid factor]], and elevated [[BUN]] and [[creatinine]] if [[glomerulonephritis]] is present.


==[[Leukocytosis]]==
==Laboratory Findings==
A marked [[leukocytosis]] is present.
Laboratory findings consistent with the diagnosis of endocarditis include:<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145  }} </ref><ref name="pmid11830803">{{cite journal| author=Dhawan VK| title=Infective endocarditis in elderly patients. | journal=Clin Infect Dis | year= 2002 | volume= 34 | issue= 6 | pages= 806-12 | pmid=11830803 | doi=10.1086/339045 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11830803  }} </ref><ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>


==[[Erythrocyte Sedimentation Rate]]==
*A marked [[leukocytosis]] is present.
An elevated [[erythrocyte sedimentation rate]] is present.


==[[Rheumatoid Factor]]==
*An elevated [[erythrocyte sedimentation rate]] is present.
A positive serum [[rheumatoid factor]] may be present and is present in approximately 50% of patients with subacute disease. It becomes negative after successful treatment.


==Renal Function==
*A positive serum [[rheumatoid factor]] may be present and is present in approximately 50% of patients with the subacute disease.
The serum [[BUN]] and [[Cr]] may be elevated if [[glomerulonephritis]] is present.


==2008 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease - Evaluation of Infective Endocarditis (DO NOT EDIT)<ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>==
*The serum [[BUN]] and [[creatinine]] may be elevated if [[glomerulonephritis]] is present.


{|class="wikitable"
*[[Glomerulonephritis]] may be present.
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Patients at risk for [[infective endocarditis]] who have unexplained [[fever]] for more than 48 h should have at least 2 sets of                              blood cultures obtained from different sites. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]])<nowiki>"</nowiki>
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Patients with known [[valvular disease]] or a [[Artificial heart valve|valve prosthesis]] should not receive [[antibiotics]] before blood cultures are obtained                              for unexplained [[fever]].  ([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]])<nowiki>"</nowiki>
|}
 
===Urinalysis===
[[Glomerulonephritis]] may be present.
 
=== Electrocardiogram ===
There is no specific [[EKG]] changes that are diagnostic of [[Infective Endocarditis]].  The [[EKG]] may be useful in the detection of the 10% of patients who develop a conduction delay during [[Infective Endocarditis]] by documenting an increased [[PR interval]].  If myocardial infarction is present, it may be due to vessel occlusion with [[ST elevation myocardial infarction]] or it may be due to distal embolism which may result in [[non ST elevation MI]].
 
=== Chest X Ray ===
There are no specific [[chest x-ray]] findings specific for the diagnosis of endocarditis. Non specific findings would include findings of [[congestive heart failure]].
 
=== MRI and CT ===
A CT scan of the head should be obtained in patients who exhibit CNS symptoms or findings consistent with a mass effect (eg, macroabscess of the brain).
 
==Sources==
*2008 ACC/AHA Guidelines incorporated into the 2006 guidelines for the management of patients with valvular heart disease <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>


==References==
==References==
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[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Infectious disease]]
 
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]

Latest revision as of 14:32, 4 March 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overivew

Laboratory findings consistent with the diagnosis of endocarditis include elevated white blood cell count, erythrocyte sedimentation rate, rheumatoid factor, and elevated BUN and creatinine if glomerulonephritis is present.

Laboratory Findings

Laboratory findings consistent with the diagnosis of endocarditis include:[1][2][3]

  • A positive serum rheumatoid factor may be present and is present in approximately 50% of patients with the subacute disease.

References

  1. ↑ Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME; et al. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145.
  2. ↑ Dhawan VK (2002). "Infective endocarditis in elderly patients". Clin Infect Dis. 34 (6): 806–12. doi:10.1086/339045. PMID 11830803.
  3. ↑ Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)

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