Endocarditis natural history, complications and prognosis: Difference between revisions
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==Natural History and Complications of Endocarditis== | |||
Complications of infective endocarditis include the following: | |||
==Cardiac== | |||
#[[Murmur]] | |||
#New aortic diastolic murmur suggests dilatation of the aortic annulus or eversion, rupture, or fenestration of an aortic leaflet | |||
#Sudden onset of loud mitral pansystolic murmur suggests rupture of chorda tendineae or fenestration of a [[mitral valve]] leaflet | |||
#[[Congestive heart failure]] | |||
#[[Arrhythmias|Cardiac rhythm disturbances]] | |||
#Occasionally, [[pericarditis]] | |||
==Cutaneous== | |||
#[[Petechiae]] of the [[conjunctiva]], [[oropharynx]], [[skin]], and legs | |||
#Linear subungual [[splinter haemorrhage]]s of the lower or middle nail bed | |||
#[[Oslers nodes]] | |||
#[[Janeway lesion]]s | |||
==Musculoskeletal== | |||
#[[Myalgias]] | |||
#[[Arthralgias]] | |||
#[[Arthritis]] | |||
#[[Low back pain]] | |||
#[[Rheumatoid factor]] in up to 50% of patients with [[endocarditis]] for > 6 wk | |||
#[[Clubbing|Clubbing of fingers]] in < 15% of patients | |||
==Ocular== | |||
#[[hemorrhages|Petechial hemorrhages]], | |||
#[[hemorrhages|Flame-shaped hemorrhages]], | |||
#[[Roth's spot]]s, | |||
#[[exudate|Cotton-wool exudates]] in the retina | |||
==Embolic== | |||
#Significant [[emboli|arterial emboli]] occur in 30%–50% of patients, causing the following: | |||
#:[[Stroke]] | |||
#:[[blindness|Monocular blindness]] | |||
#:[[abdominal pain|Acute abdominal pain]], [[ileus]], and [[melena]] | |||
#:[[Pain]] and [[gangrene]] in the extremities | |||
#[[emboli|CNS emboli]] are common | |||
#[[emboli|Coronary emboli]], often asymptomatic, can cause [[myocardial infarction]] | |||
#[[Pulmonary emboli]] common in right-sided [[endocarditis]], causing pulmonary infarcts or focal [[pneumonitis]] | |||
==Splenic== | |||
#[[Splenomegaly]] in 15%–30% of patients | |||
#[[Splenic |Splenic infarcts]] in up to 40% of patients | |||
#[[Splenic |Splenic abscess]]es in ~ 5% of patients | |||
==Renal== | |||
#[[hematuria|Microscopic hematuria]] in ~ 50% of patients | |||
#Embolic renal infarction | |||
#[[membranoproliferative glomerulonephritis|Diffuse membranoproliferative glomerulonephritis]] | |||
==Mycotic aneurysms== | |||
Occur in any artery in 2%–8% of patients, causing the following: | |||
#[[Pain]] or [[headache]] | |||
#Pulsatile mass | |||
#[[Fever]] | |||
#[[hematoma|Sudden expanding hematoma]] | |||
#Signs of major blood loss | |||
==Neurologic== | |||
#Neurologic complications occur in 25%–40% of cases | |||
#[[Stroke]]s caused by cerebral embolisms in ~ 15% of cases, causing the following: | |||
#:[[consciousness|Altered level of consciousness]] | |||
#:[[Seizures]] | |||
#:Fluctuating focal neurologic signs | |||
#Cerebral aneurysms occur in 1%–5% of cases, causing the following: | |||
#:[[Headache]] | |||
#:Focal signs | |||
#:Acute [[intracerebral hemorrhage|intracerebral]] or [[subarachnoid hemorrhage]] caused by rupture | |||
#:Mild meningeal irritation resulting from slow leakage | |||
#[[Brain abscess]]es may occur in acute [[endocarditis]] caused by [[Staphylococcus aureus]] | |||
#[[Seizure]]s | |||
Among those patients at high risk, careful monitoring should be undertaken to detect the early development of complications such as: | |||
#Valvular dysfunction, usually insufficiency of the mitral or aortic valves; | |||
#Myocardial or septal [[abscess]]es | |||
#[[Congestive heart failure]] | |||
#Metastatic infection | |||
#Embolic phenomenon | |||
{{SI}} | {{SI}} | ||
Revision as of 15:18, 20 March 2011
Natural History and Complications of Endocarditis
Complications of infective endocarditis include the following:
Cardiac
- Murmur
- New aortic diastolic murmur suggests dilatation of the aortic annulus or eversion, rupture, or fenestration of an aortic leaflet
- Sudden onset of loud mitral pansystolic murmur suggests rupture of chorda tendineae or fenestration of a mitral valve leaflet
- Congestive heart failure
- Cardiac rhythm disturbances
- Occasionally, pericarditis
Cutaneous
- Petechiae of the conjunctiva, oropharynx, skin, and legs
- Linear subungual splinter haemorrhages of the lower or middle nail bed
- Oslers nodes
- Janeway lesions
Musculoskeletal
- Myalgias
- Arthralgias
- Arthritis
- Low back pain
- Rheumatoid factor in up to 50% of patients with endocarditis for > 6 wk
- Clubbing of fingers in < 15% of patients
Ocular
- Petechial hemorrhages,
- Flame-shaped hemorrhages,
- Roth's spots,
- Cotton-wool exudates in the retina
Embolic
- Significant arterial emboli occur in 30%–50% of patients, causing the following:
- Stroke
- Monocular blindness
- Acute abdominal pain, ileus, and melena
- Pain and gangrene in the extremities
- CNS emboli are common
- Coronary emboli, often asymptomatic, can cause myocardial infarction
- Pulmonary emboli common in right-sided endocarditis, causing pulmonary infarcts or focal pneumonitis
Splenic
- Splenomegaly in 15%–30% of patients
- Splenic infarcts in up to 40% of patients
- Splenic abscesses in ~ 5% of patients
Renal
- Microscopic hematuria in ~ 50% of patients
- Embolic renal infarction
- Diffuse membranoproliferative glomerulonephritis
Mycotic aneurysms
Occur in any artery in 2%–8% of patients, causing the following:
- Pain or headache
- Pulsatile mass
- Fever
- Sudden expanding hematoma
- Signs of major blood loss
Neurologic
- Neurologic complications occur in 25%–40% of cases
- Strokes caused by cerebral embolisms in ~ 15% of cases, causing the following:
- Altered level of consciousness
- Seizures
- Fluctuating focal neurologic signs
- Cerebral aneurysms occur in 1%–5% of cases, causing the following:
- Headache
- Focal signs
- Acute intracerebral or subarachnoid hemorrhage caused by rupture
- Mild meningeal irritation resulting from slow leakage
- Brain abscesses may occur in acute endocarditis caused by Staphylococcus aureus
- Seizures
Among those patients at high risk, careful monitoring should be undertaken to detect the early development of complications such as:
- Valvular dysfunction, usually insufficiency of the mitral or aortic valves;
- Myocardial or septal abscesses
- Congestive heart failure
- Metastatic infection
- Embolic phenomenon
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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