Endocarditis natural history, complications and prognosis: Difference between revisions
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== | {{SI}} | ||
{{CMG}} | |||
{{EJ}} | |||
==Monitoring for Complications of Infectious Endocarditis== | |||
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 | |||
A complete list of complications of infective endocarditis include the following: | |||
==Cardiac== | ==Cardiac== | ||
#[[Murmur]] | # [[Murmur]] | ||
# | # A new aortic [[diastolic murmur]] suggests dilatation of the aortic annulus or eversion, rupture, or fenestration of an aortic leaflet | ||
# | # The sudden onset of a loud mitral pansystolic murmur suggests rupture of [[chorda tendineae]] or fenestration of a [[mitral valve]] leaflet | ||
#[[Congestive heart failure]] | # [[Congestive heart failure]] | ||
#[[Arrhythmias|Cardiac rhythm disturbances]] | # [[Arrhythmias|Cardiac rhythm disturbances]] | ||
#Occasionally, [[pericarditis]] | # Occasionally, [[pericarditis]] | ||
==Cutaneous== | ==Cutaneous== | ||
#[[Petechiae]] of the [[conjunctiva]], [[oropharynx]], [[skin]], and legs | # [[Petechiae]] of the [[conjunctiva]], [[oropharynx]], [[skin]], and legs | ||
#Linear subungual [[splinter haemorrhage]]s of the lower or middle nail bed | # Linear subungual [[splinter haemorrhage]]s of the lower or middle nail bed | ||
#[[Oslers nodes]] | # [[Oslers nodes]] | ||
#[[Janeway lesion]]s | # [[Janeway lesion]]s | ||
==Musculoskeletal== | ==Musculoskeletal== | ||
#[[Myalgias]] | # [[Myalgias]] | ||
#[[Arthralgias]] | # [[Arthralgias]] | ||
#[[Arthritis]] | # [[Arthritis]] | ||
#[[Low back pain]] | # [[Low back pain]] | ||
#[[Rheumatoid factor]] in up to 50% of patients with [[endocarditis]] for > 6 wk | # [[Rheumatoid factor]] is elevated in up to 50% of patients with [[endocarditis]] for > 6 wk | ||
#[[Clubbing|Clubbing of fingers]] in < 15% of patients | # [[Clubbing|Clubbing of fingers]] is present in < 15% of patients | ||
==Ocular== | ==Ocular== | ||
# | # Petechial hemorrhages | ||
# | # Flame-shaped hemorrhages | ||
#[[Roth's spot]]s, | # [[Roth's spot]]s, | ||
# | # Cotton-wool exudates in the [[retina]] | ||
==Embolic== | ==Embolic== | ||
#Significant [[emboli|arterial emboli]] occur in 30%–50% of patients, causing the following: | # Significant [[emboli|arterial emboli]] occur in 30%–50% of patients, causing the following: | ||
#:[[Stroke]] | #: [[Stroke]] | ||
#:[[blindness|Monocular blindness]] | #: [[blindness|Monocular blindness]] | ||
#:[[abdominal pain|Acute abdominal pain]], [[ileus]], and [[melena]] | #: [[abdominal pain|Acute abdominal pain]], [[ileus]], and [[melena]] | ||
#:[[Pain]] and [[gangrene]] in the extremities | #: [[Pain]] and [[gangrene]] in the extremities | ||
#[[emboli|CNS emboli]] are common | # [[emboli|CNS emboli]] are common | ||
#[[emboli|Coronary emboli]], often asymptomatic, can cause [[myocardial infarction]] | # [[emboli|Coronary emboli]], often asymptomatic, can cause [[myocardial infarction]] | ||
#[[Pulmonary emboli]] common in right-sided [[endocarditis]], causing pulmonary infarcts or focal [[pneumonitis]] | # [[Pulmonary emboli]] common in right-sided [[endocarditis]], causing pulmonary infarcts or focal [[pneumonitis]] | ||
==Splenic== | ==Splenic== | ||
#[[Splenomegaly]] in 15%–30% of patients | # [[Splenomegaly]] is observed in 15%–30% of patients | ||
#[[Splenic |Splenic infarcts]] in up to 40% of patients | # [[Splenic |Splenic infarcts]] occur in up to 40% of patients | ||
#[[Splenic |Splenic abscess]]es in ~ 5% of patients | # [[Splenic |Splenic abscess]]es occur in ~ 5% of patients | ||
==Renal== | ==Renal== | ||
#[[hematuria|Microscopic hematuria]] in ~ 50% of patients | # [[hematuria|Microscopic hematuria]] occurs in ~ 50% of patients | ||
#Embolic renal infarction | # Embolic [[renal infarction]] | ||
#[[membranoproliferative glomerulonephritis|Diffuse membranoproliferative glomerulonephritis]] | # [[membranoproliferative glomerulonephritis|Diffuse membranoproliferative glomerulonephritis]] | ||
==Mycotic aneurysms== | ==Mycotic aneurysms== | ||
Occur in any artery in 2%–8% of patients, causing the following: | Occur in any artery in 2%–8% of patients, causing the following: | ||
#[[Pain]] or [[headache]] | # [[Pain]] or [[headache]] | ||
#Pulsatile mass | # Pulsatile mass | ||
#[[Fever]] | # [[Fever]] | ||
#[[hematoma|Sudden expanding hematoma]] | # [[hematoma|Sudden expanding hematoma]] | ||
#Signs of major blood loss | # Signs of major blood loss | ||
==Neurologic== | ==Neurologic== | ||
#Neurologic complications occur in 25%–40% of cases | # Neurologic complications occur in 25%–40% of cases | ||
#[[Stroke]]s caused by cerebral embolisms in ~ 15% of cases, causing the following: | # [[Stroke]]s caused by cerebral embolisms in ~ 15% of cases, causing the following: | ||
#:[[consciousness|Altered level of consciousness]] | #: [[consciousness|Altered level of consciousness]] | ||
#:[[Seizures]] | #: [[Seizures]] | ||
#:Fluctuating focal neurologic signs | #: Fluctuating focal neurologic signs | ||
#Cerebral aneurysms occur in 1%–5% of cases, causing the following: | # Cerebral aneurysms occur in 1%–5% of cases, causing the following: | ||
#:[[Headache]] | #: [[Headache]] | ||
#:Focal signs | #: Focal signs | ||
#:Acute [[intracerebral hemorrhage|intracerebral]] or [[subarachnoid hemorrhage]] caused by rupture | #: Acute [[intracerebral hemorrhage|intracerebral]] or [[subarachnoid hemorrhage]] caused by rupture | ||
#:Mild meningeal irritation resulting from slow leakage | #: Mild meningeal irritation resulting from slow leakage | ||
#[[Brain abscess]]es may occur in acute [[endocarditis]] caused by [[Staphylococcus aureus]] | # [[Brain abscess]]es may occur in acute [[endocarditis]] caused by [[Staphylococcus aureus]] | ||
#[[Seizure]]s | # [[Seizure]]s | ||
Revision as of 15:29, 20 March 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Monitoring for Complications of Infectious Endocarditis
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
A complete list of complications of infective endocarditis include the following:
Cardiac
- Murmur
- A new aortic diastolic murmur suggests dilatation of the aortic annulus or eversion, rupture, or fenestration of an aortic leaflet
- The sudden onset of a 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 is elevated in up to 50% of patients with endocarditis for > 6 wk
- Clubbing of fingers is present 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 is observed in 15%–30% of patients
- Splenic infarcts occur in up to 40% of patients
- Splenic abscesses occur in ~ 5% of patients
Renal
- Microscopic hematuria occurs 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