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The turbulent blood flow around the heart valves is a risk factor for the development of endocarditis.  The valves may be damaged congenitally, from [[surgery]], by [[auto-immune]] mechanisms, or simply as a consequence of old age.  The damaged endothelium of these areas becomes a site for attachment of infectious agents in infectious endocarditis.  Dental procedures, [[colorectal cancer]], [[urinary tract infections]] and [[intravenous drug use]] are the most common routes of introducing the infectious agent into the bloodstream.  The three most common pathogens are strepotococcus viridans, staphylococcus and enterococcus.  In non-bacterial thrombotic endocarditis (NBTE), the damaged part of a heart valve becomes covered with a blood clot which organizes.
The turbulent blood flow around the heart valves is a risk factor for the development of endocarditis.  The valves may be damaged congenitally, from [[surgery]], by [[auto-immune]] mechanisms, or simply as a consequence of old age.  The damaged endothelium of these areas becomes a site for attachment of infectious agents in infectious endocarditis.  Dental procedures, [[colorectal cancer]], [[urinary tract infections]] and [[intravenous drug use]] are the most common routes of introducing the infectious agent into the bloodstream.  The three most common pathogens are strepotococcus viridans, staphylococcus and enterococcus.  In non-bacterial thrombotic endocarditis (NBTE), the damaged part of a heart valve becomes covered with a blood clot which organizes.


==Bacteremia==
==Pathophysiology==
In a healthy individual, a [[bacteremia]] (where bacteria get into the blood stream through a minor cut or wound) would normally be cleared quickly with no adverse consequences. If a heart valve is damaged and covered with [[thrombus]], these structures can provide a nidus for bacteria to attach themselves and an infection can be established.
 
 
===Pathogenesis===
 
===Associated Conditions===
===Gross Pathology===
===Microscopic Pathology===
 


==Pathogens==
==Pathogens==

Revision as of 15:52, 21 September 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The turbulent blood flow around the heart valves is a risk factor for the development of endocarditis. The valves may be damaged congenitally, from surgery, by auto-immune mechanisms, or simply as a consequence of old age. The damaged endothelium of these areas becomes a site for attachment of infectious agents in infectious endocarditis. Dental procedures, colorectal cancer, urinary tract infections and intravenous drug use are the most common routes of introducing the infectious agent into the bloodstream. The three most common pathogens are strepotococcus viridans, staphylococcus and enterococcus. In non-bacterial thrombotic endocarditis (NBTE), the damaged part of a heart valve becomes covered with a blood clot which organizes.

Pathophysiology

Pathogenesis

Associated Conditions

Gross Pathology

Microscopic Pathology

Pathogens

Causes of Bacteremia

Dental Procedures

The bacteremia is often caused by dental procedures, such as a cleaning or extraction of a tooth. It is important that a dentist or a dental hygienist therefore be told of any heart problems before beginning the procedure. Prophylactic antibiotics are administered to patients with certain heart conditions as a precaution.

Entrance of Bacteria Into the Bloodstream

Another cause of infective endocarditis is a scenario in which an excess number of bacteria enter the bloodstream. Colorectal cancer, serious urinary tract infections, and IV drug use can all introduce large numbers of such bacteria. When a large burden of bacteria are introduced, a normal heart valve may be infected. A more virulent organism (such as Staphylococcus aureus, but see below for others) is often responsible for infecting a normal valve.

Intravenous Drug Use

Infections of the tricuspid valve and less frequently the pulmonic valve tend to occur in intravenous drug users given the high pathogen burden from their introduction in the vein. The diseased valve is most commonly affected when there is a pre-existing disease. In rheumatic heart disease this is the aortic valve and the mitral valves, on the left side of the heart.

Pathology

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

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