Epidemiology Clinical Features Diagnosis Treatment

Endocarditis Prosthetic valves Complications: High index of suspicion Antibiotics (bacteriocidal

(greatest overall) - local destructive and bacteriostatic); IV, 6
Injury to endothelium effects of bacteria Positive blood cultures weeks avg.
- high velocity jet IV drug use: (greatest - embolization
impacting on individual) - hematologic Visible vegetations Surgical excision
surface seeding of remote (refractory bacteremia,
- flow from high to MVP (most common sites New valvular regurg severe valve distruction,
low pressure area structural abnormality - chronic Ab emboli, large vegetations,
- flow through associated) response Minor: persistent fever, perivalvular abscess)
narrow orifice vascular phenomena,
Rheumatic Heart Disease Fever immunologic, thickened Antibiotic prophylaxis
Bacterial resistance to valves on echo (prevention): valvular
immunity Congenital Cardiac New murmur stenosis or regurg; VSD,
Abnormalities: PDA, 2 major or 1 major and 3 valve replacement, MVP
Platelet adherence and ventriculoseptal defect, Splenomegaly minor criteria w/ regurg; prior
initiation of clotting bicuspid aortic valve endocarditis
cascade Petechiae Labs: blood cultures,
Microbiology: rheumatoid factor,
- S. viridans Splinter hemorrhages anemia or chonic disease
(overall)
- S. aureus (IV drug Oslers nodes Echo: valve vegetations,
abuse) perivalvular abcess
- S. epidermidis Musculoskeletal
(valve surgery symptoms
1st 60 days)
Systemic emboli

Neurological symptoms

CHF

Renal insufficieny or
failure