Endocarditis refers to endothelial damage with thrombosis on endocardial surfaces, typically on the heart valves see the image below. Management considerations in infective endocarditis. Pathogens gain access to the bloodstream adheres to the compromised cardiac tissue. Acute bacterial endocarditis is fulminating infection associated with high fevers, systemic toxicity, and death within days to weeks if untreated. Patients with infective endocarditis need prompt diagnosis and a rapid. Infective endocarditis is an infection of the lining of the heart endocardium and usually also of the heart valves. The pathophysiology behind ie involves damage to the cardiac endothelium allowing bacterial infection to occur. Infective endocarditis is an infection of the endocardium by offending agents. Infective endocarditis guidelines on prevention, diagnosis and treatment of. Ppt infective endocarditis powerpoint presentation. Even with modern investigation techniques, diagnosing infective endocarditis can be hugely challenging, yet is critically important in patients. Moreover, changes in pathogen prevalence,in particular a more common staphylococcal origin, have affected outcomes. The clinical picture of infectious endocarditis ieits microorganisms, diagnostic criteria duke and modified duke criteria,1,2 involved valve, native versus prosthetic valve, and complicationshas been well described.
It is most commonly caused by bacterial and fungal infections, although noninfective causes of endocarditis occur, this chapter will concentrate on infective causes. Infective endocarditis ie is an infectious and inflammatory process of endothelial lining of the heart structures and valves. Pathophysiology of infective endocarditis request pdf. Clin infect dis, 2000 mimics of infective endocarditis atrial myxomaatrial myxoma marantic endocarditis left atrial thrombus acute rheumatic fever with carditis collagen vascular disease sle. Infective endocarditis occurs worldwide, and is defined by infection of a native or prosthetic heart valve, the endocardial surface, or an. Infective endocarditis is a lifethreatening disease whose pathophysiology is based on unique hostpathogen interaction. A variety of organ systems may be adversely affected in patients with ie. The epidemiology of infective endocarditis has become more complex with todays myriad healthcareassociated factors that predispose to infection. Pdf infective endocarditis clinical presentation and outcome in.
Definitions a microbial infection of a cardiac valve or the endocardium caused by bacteria, fungi, or chlamydia often categorized as acute or s ubacute based on the rapidity of the clinical course alternatively described by type of risk factor e. The causes and epidemiology of the disease have evolved in recent decades. Infective endocarditis ie is a rare disease that can be difficult to manage and treat due to the complex nature of the disease process. Pathogenesis includes preexisting endocardial lesions or inflammation that leads to endothelial cells and platelets activation, coagulation and thrombus formation. Moreover, changes in pathogen prevalence, in particular a more common. Infective endocarditis occurs worldwide, and is defined by infection of a native or prosthetic heart valve, the endocardial surface, or an indwelling cardiac device. Vegetations may result in valvular incompetence or obstruction. The task force for the management of infective endocarditis of the. Pathophysiology of infective endocarditis, current. Infective and non infective related causes must be distinguished. Infective endocarditis ie is an infection of a heart valve or other cardiac structure at a site of endothelial damage. Vegetations may result in valvular incompetence or obstruction, myocardial abscess, or mycotic aneurysm. Some details of 544 episodes of infective endocarditis occurring in 541 patients during 1981 and 1982 are reported. Pathophysiology and causes of endocarditis oxford medicine.
Of the 544 episodes 347 63% were due to streptococci, 19% to staphylococci, and 14% to bowel organisms. This may include heart valves, mural endocardium or the endocardium that covers implanted material, such as prosthetic valves, pacemakerdefibrillator leads and catheters. The pathophysiology involves various factors including the cardiac endothelium, hemostatic mechanisms, the immune system, cardiac anatomic abnormalities, and surface properties of microorganisms. The microbiology and pathogenesis of infective endocarditis. Moreover, if the valve annulus is affected, the infection will spread into.
It may cause fever, heart murmurs, petechiae, anemia, embolic phenomena, and endocardial vegetations. This infection grows and causes a multitude of issues for the. Formerly known as bacterial endocarditis, endocardial infections are currently named infective endocarditis in order to include both bacterial and fungal microorganisms. Endocarditis is defined as an inflammation of the endocardial surface of the heart. The pathophysiology of infective endocarditis comprises at least three critical elements. Although recognized as prognostically important, the pathologic description has often been limited to the. Epidemiology diagnosis imaging therapy and prevention author gilbert habib file size 11.
Infective endocarditis arises when an adherent plateletfibrin nidus becomes secondarily infected and produces vegetations, which in turn may directly damage the endocardial tissue andor valves. The relation of vegetations on the valve to an underlying interstitial valvulitis and of the bacterial to the nonbacterial vegetation is still moot. The causes and epidemiology of the disease have evolved in recent decades with a doubling of the average patient age and an increased prevalence in patients with indwelling cardiac devices. Infective endocarditis ie is a rare, lifethreatening disease that has. The definition has been also expanded to include infected cardiac devices. Infective endocarditis ie is a rare, lifethreatening disease that has longlasting effects even among patients who su. Infective endocarditis and noninfective endocarditis lecture on the nursing management, pathophysiology, treatment, signs and symptoms. Pathology and pathogenesis of infective endocarditis in. In contrast, interfering with bacterial virulence factors might be more complicated because they vary among different bacteria. This poster details the significance of ie, its underlying pathophysiology, significance of pathophysiology, signs and symptoms, and nursing implications.
Pathophysiology of infective endocarditis springerlink. Definition of infective endocarditis infective endocarditis, a serious infection ofthe endocardium of the heart, particularly theheart valves, is associated with a high degreeof illness and death. The ability of an organism to cause endocarditis is the result of. Infection most commonly involves heart valves but may also occur on the lowpressure side of a ventricular septal defect, on mural endocardium damaged by aberrant jets of blood or foreign bodies, or on intracardiac devices themselves. Improvement in surgical and medical therapeutics have been encouraging, however, if managed poorly it can still have a poor prognosis. There are a variety of causes that result in endocarditis. Pathophysiology of infective endocarditis pathophysiology of infective endocarditis keynan, yoav. Infective endocarditis vegetations arrows due to viridans streptococcal endocarditis involving the mitral valve. Guidelines recommend that an endocarditis team operating in a reference centre is crucial for the management of ie reference centres should have immediate. Infective endocarditis affects twice as many men as women at all ages. Infective endocarditis ie is a condition in which there is microbial.
Esc clinical practice guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on infective endocarditis. European association for cardiothoracic surgery eacts, the european association of nuclear medicine eanm authorstask force members. In most cases, the inflammation is related to a bacterial or fungal. Why such an entity prevails at all requires elucidation. One potential outcome a patient using iv drugs may experience is infective endocarditis ie. Pdf infective endocarditis ie is the infection of oneor more heart valves. They should be essential in everyday clinical decision making. Intravenous drug use ivdu is an activity that has the potential of devastating outcomes and affects individuals all over the world. Treatment options being the high dose antibiotics e.
Infective endocarditis ie is an evolving disease with a persistently high mortality and morbidity, even in the modern era of advanced diagnostic imaging, improved antimicrobial chemotherapy, and. Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. Infective endocarditis is infection of the endocardium, usually with bacteria commonly, streptococci or staphylococci or fungi. An increasingly elderly population with degenerative heart valve disease and an increase in staphylococcal infections have contributed to an increase. Infective endocarditis esc guidelines on prevention, diagnosis. Sir william osler meticulously described the clinical manifestations of infective endocarditis in 1885, concluding that. Request pdf pathophysiology of infective endocarditis infective endocarditis ie is an uncommon infection, occurring as a complication in varying percentages of bacteremic episodes. Infective endocarditis ie is a severe bacterial infection of the endocardial surface of the heart. Pathophysiology of infective endocarditis ie associated. Boosted the role of imaging in diagnosis while the 2009 guidelines focused on echo, the 2015 guidelines show the important role of petct and spectct.
Infective endocarditis results from interactions between the human host and responsible microorganisms. Infective endocarditis an overview sciencedirect topics. Infective endocarditis ie is a microbial usually bacteria infection affecting the heart tissue or the adjacent vascular endothelium. Infective endocarditis ie is an uncommon infection, occurring as a complication in varying percentages of bacteremic episodes. Endocarditis nursing pathophysiology treatment infective. The ability of an organism to cause endocarditis is the result of an interplay between the predisposing structural. Acute infective endocarditis generally is caused by staphylococcus, pneumococcus, or gonococcus bacteria or by fungi.
A free powerpoint ppt presentation displayed as a flash slide show on id. Efforts to develop a vaccine targeting common bacterial causes of ie are. Infective endocarditis 2016 pdf medical books free download. More than one fourth of all cases occur in people older than 60. The ability of an organism to cause endocarditis is the result of an interplay between the predisposing structural abnormalities of the cardiac valve for bacterial adherence, the adhesion of circulating bacteria to the valvular surface, and the ability of the.
Infective endocarditis is defined by a focus of infection within the heart and is a feared disease across the field of cardiology. It most commonly occurs at sites that have had previous damage. It generally occurs inpatients with altered and abnormal heartarchitecture, in combination with exposure tobacteria through trauma and other. Pathophysiology the development of infectious endocarditis requires the presence of bacteria or fungi in the blood and an intracardiac surface on which these microorganisms can attach. New concepts in the pathophysiology of infective endocarditis. Infective endocarditis ie refers to infection of heart valves by microorganisms, primarily bacteria. A wide variety of other organisms were responsible for a few cases, and 10% were. The epidemiology of infective endocarditis has become more complex with todays myriad healthcare associated factors that predispose to infection. Infective endocarditis harrisons principles of internal.
Remember, if theres a fever with a new murmur, think infective endocarditis. Treatment with antimalarials and various antibiotics preceded the diagnosis in 46. Several enigmas about the mechanism of valvular endocarditis still exist. Pathophysiology of infective endocarditis by blake. Pdf 2015 esc guidelines for the management of infective. Despite optimal care, mortality approaches 30% at 1 year.
The prototypic lesion of infective endocarditis, the vegetation, is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. Infective endocarditis heart and blood vessel disorders. Importance infective endocarditis occurs in approximately 15 of 100 000 people in the united states and has increased in incidence. The causes and epidemiology of the disease have evolved in recent. Pathogenesis of bacterial endocarditis jama jama network. Infective endocarditis cardiovascular disorders merck. Current aats guidelines on surgical treatment of infective.
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