Endocarditis pathophysiology: Difference between revisions
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==Overview== | ==Overview== | ||
The pathogenesis of infective endocarditis includes valvular damage, altered and turbulent flow, bacteremia, and lack of blood supply to the [[valve]]s. | 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. | ||
==Pathophysiology== | ==Pathophysiology== | ||
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===Pathogenesis=== | ===Pathogenesis=== | ||
====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:<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> | ||
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====Nonbacterial | ====Nonbacterial Thrombotic Endocarditis==== | ||
*[[Nonbacterial thrombotic endocarditis]] (NBTE), also called '''marantic endocarditis''' is most commonly found on previously undamaged valves. | *[[Nonbacterial thrombotic endocarditis]] (NBTE), also called '''marantic endocarditis''' is most commonly found on previously undamaged valves. | ||
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*[[Libman-Sacks endocarditis]] is another form of sterile endocarditis; this form occurs more often in patients with [[lupus erythematosus]] and is thought to be due to the deposition of immune complexes. | *[[Libman-Sacks endocarditis]] is another form of sterile endocarditis; this form occurs more often in patients with [[lupus erythematosus]] and is thought to be due to the deposition of immune complexes. | ||
*[[Libman-Sacks endocarditis]] involves small vegetations, while infective endocarditis is composed of large vegetations. These immune complexes precipitate an inflammatory reaction, which helps to differentiate it from NBTE. | *[[Libman-Sacks endocarditis]] involves small vegetations, while infective endocarditis is composed of large vegetations. These immune complexes precipitate an inflammatory reaction, which helps to differentiate it from NBTE. | ||
*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.<ref name=endo> Endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Endocarditis Accessed on September 21, 2015</ref> | *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.<ref name="endo"> Endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Endocarditis Accessed on September 21, 2015</ref> | ||
== Genetics == | |||
== Associated Conditions == | |||
== Gross Pathology == | |||
== Microscopic Pathology == | |||
===Gross and Microscopic Pathology=== | ===Gross and Microscopic Pathology=== | ||
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[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 PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] | ||
Revision as of 14:31, 2 January 2020
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Endocarditis Microchapters |
Diagnosis |
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Treatment |
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease |
Case Studies |
Endocarditis pathophysiology On the Web |
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 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.
Pathophysiology
Pathogenesis
Infective Endocarditis
The pathogenesis of infective endocarditis includes:[1][2]
Pathogenic Factors | Mechanism |
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Nonbacterial Thrombotic Endocarditis
- Nonbacterial thrombotic endocarditis (NBTE), also called marantic endocarditis is most commonly found on previously undamaged valves.
- The vegetations in NBTE are small, sterile, and tend to aggregate along the edges of the valve or the cusps.
- Unlike infective endocarditis, NBTE does not cause an inflammation response from the body.
- NBTE usually occurs due to hypercoaguable states such as systemic bacterial infection or pregnancy. NBTE may also occur in patients with cancer, particularly mucinous adenocarcinoma.
- Libman-Sacks endocarditis is another form of sterile endocarditis; this form occurs more often in patients with lupus erythematosus and is thought to be due to the deposition of immune complexes.
- Libman-Sacks endocarditis involves small vegetations, while infective endocarditis is composed of large vegetations. These immune complexes precipitate an inflammatory reaction, which helps to differentiate it from NBTE.
- 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]
Genetics
Associated Conditions
Gross Pathology
Microscopic Pathology
Gross and Microscopic Pathology
The characteristic lesion of endocarditis is a vegetation. Vegetations are composed of fibrin, inflammatory cells, platelets, and microorganisms.[3] Characteristic features of endocarditis on gross pathology and histopathological analysis include:[4]
Endocarditis Subtype | Features on Gross Pathology | Features on Histopathological Microscopic Analysis |
Infective Endocarditis |
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Nonbacterial Thrombotic Endocarditis |
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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.
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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
- ↑ Infective endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Infective_endocarditis#Pathogenesis Accessed on September 21, 2015
- ↑ 2.0 2.1 Endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Endocarditis Accessed on September 21, 2015
- ↑ Mylonakis E, Calderwood SB (2001). "Infective endocarditis in adults". N Engl J Med. 345 (18): 1318–30. doi:10.1056/NEJMra010082. PMID 11794152.
- ↑ Infective Endocarditis. Libre Pathology (2015). URL=http://librepathology.org/wiki/index.php/Infective_endocarditis Accessed on September 21, 2015