Infective endocarditis resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farman Khan, MD, MRCP [2]

Definition

Infection of the endothelium of the heart including but not limited to the valves. It can be either acute or subacute. Acute bacterial endocarditis is defined as Infection of normal heart valves with a virulent organism like S. aureus, Group A or other beta-hemolytic streptococci, Streptococcus pneumoniae. Subacute bacterial endocarditis is an indolent infection of abnormal valves with less virulent organism like Streptococcus viridans.

Definite Infective Endocarditis According to Modified Duke Criteria

Pathological criteria ❑ Microorganisms demonstrated by culture or histological examination of a vegetation ❑ Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis Clinical Criteria ❑ 2 major criteria; or ❑ 1 major criterion and 3 minor criteria; or ❑ 5 minor criteria Possible IE ❑ 1 major criterion and 1 minor criterion; or ❑ 3 minor criteria Rejected ❑ Firm alternative diagnosis explaining evidence of IE; or ❑ Resolution of IE syndrome with antibiotic therapy for 4 days; or ❑ No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days; or ❑ Does not meet criteria for possible IE as above

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Endocarditis can be a life-threatening condition if it is left untreated, and it must be treated as such irrespective of the causes.

Common Causes

• Streptococcus viridans
• Staphylococci
• Enterococcus.

Management

Shown below is an algorithm summarizing the approach to Endocarditis.

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References

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