Acute Infective Endocarditis
Section snippets
Pathogenesis
Vegetation formation is a multistep process. The first step is endocardial injury, which may occur by many mechanisms. The most common mechanism is injury by turbulent blood flow from an acquired or congenital intracardiac abnormality. The most common site of such injury, and thus the most common site of vegetation formation, is on the line of closure of a valve surface, typically on the atrial surface of atrioventricular valves or on the ventricular surface of semilunar valves.2 Alternatively,
Demographics and Risk Factors
The incidence of IE is between 2 and 10 episodes per 100,000 person-years in most population-based studies,7, 8, 9 and as high as 20 episodes per 100,000 person-years in the elderly.10 There are approximately 15,000 new cases of IE diagnosed each year in the United States, and it accounts for about 1 in 1000 admissions to the hospital.11
Most studies demonstrate that the rate of IE has been stable over time,12, 13 though changes in diagnostic tools and criteria make temporal comparisons
Diagnostic criteria
The Duke criteria incorporate information from echocardiography, history and physical examination, microbiology, and pathology to diagnose IE (Box 1). They were originally proposed in 1994,33 and were subsequently shown to be superior to previous diagnostic criteria.34, 35 The criteria were modified in 2000 to revise the definition of “possible IE,” add criteria for microbiologic diagnosis of Q fever IE, eliminate echocardiographic minor criteria, and include recommendations for choosing
Specific organisms
For IE caused by organisms not addressed below or in Tables 1 and 2, the American Heart Association's Scientific Statement on Infective Endocarditis should be consulted for treatment recommendations.40
Congestive Heart Failure
CHF is the most common complication of both NVE and PVE, occurring in over half of all cases of IE.2 It is usually caused by valvular dysfunction, not myocardial failure,54 and is most commonly associated with aortic valve dysfunction.56, 57 In retrospective studies of IE patients with CHF, medical management alone is associated with higher mortality than surgical and medical management combined,56 even after adjustment for propensity to receive surgical therapy.51
Intracardiac Abscess
Intracardiac abscesses occur
Prevention
Though there have been no randomized controlled trials that prove the effectiveness of IE prophylaxis around the time of dental, gastrointestinal, or genitourinary (GU) procedures, it has been common practice since the 1950s.4 Recent literature, however, has shown that only a small percentage of IE cases are attributable to dental procedures, and that a huge amount of prophylaxis would be needed to prevent only a small number of cases.4, 108, 109
The most recent practice guideline from the
Summary
Acute IE is a complex disease with changing epidemiology and a rapidly evolving knowledge base. To consistently achieve optimal outcomes in the management of IE, the clinical team must have an understanding of the epidemiology, microbiology, and natural history of IE, as well as a grasp of the guiding principles of diagnosis and medical and surgical management.
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Impact of routine brain imaging on the prognosis of patients with left-sided valve infective endocarditis without neurological manifestations
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2022, Infective Endocarditis: A Multidisciplinary ApproachAortic valve endocarditis in patients with bicuspid and tricuspid aortic valves
2021, JTCVS OpenCitation Excerpt :Patients with BAV have previously been shown to have earlier onset of valve thickening and a higher incidence of aortic stenosis compared with the general population.16 The underlying pathophysiology is thought to be related to the abnormal shear stress of turbulent blood flow across bicuspid valves, which over time may lead to endocardial tissue damage, fibrosis, and subsequent valve calcification, which can increase the likelihood of formation of infectious vegetation on valves.11,16-18 The severe calcification could be one reason why native BAV may be more susceptible to bacterial infection and help explain our findings in the BAV group.
Multiorgan emboli due to an intraluminal thrombus from frozen elephant trunk
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This work was supported by grant number K12RR023249 and KL2RR024994 from the National Institutes of Health.