Endocarditis natural history, complications and prognosis
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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