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Infektiose Endokarditis

Infektiöse Endokarditis: Pathogenese, klinische Befunde und Komplikationen

Infective endocarditis

Infective Endocarditis: Pathogenesis, complications, and clinical findings Subacute Endocarditis Pre-existing valvular stenosis or regurgitation Non-laminar flow across valve damages valve endothelium A sterile thrombus forms Thrombus forms on the surface of a cardiac valve Acute Endocarditis Poor dental hygiene/recent dental procedure Invasive procedure/indwelling device Positive blood cultures Activation of immune system Valve Trauma Invading bacterium Intravenous (IV) drug use (mostly causes right sided endocarditis) Bacteria enter the bloodstream (bacteremia) In subacute cases, valvular abnormality usually present beforehand In all cases, vegetation forms on affected valve Immune complex deposit in kidney Immune complexes cause vasculitis in retinal vessels Immune complexes deposit subcutaneously ↓ Blood flow to organs perfused by the obstructed arteries Valve endothelium is damaged Bacteria adhere to thrombi on the cardiac valve endothelium Infective Endocarditis Infection of the thrombus typically produces a vegetation on the flow surface of a valve Immune complexes (complexes of antibody bound to antigen) form secondary to infection Generalized immune response Malaise Chills Fever (> 38°C) Author: Sean Spence George S. Tadros Reviewers: Yan Yu Jason Baserman Danny Guo Steve Vaughan* *MD at time of publication Parts of vegetation embolize systemically, obstructing arteries Infection destroys infected valve Smaller emboli block smaller vessels on hands/feet Microinfarctions Mitral regurgitation, Aortic stenosis, Aortic insufficiency (Valve involvement: Mitral > Aortic > Tricuspid) Vegetation seen on ultrasound/echocardiogram Damage to Glomerulonephritis glomeruli (Inflammation of glomeruli) Roth’s spots (retinal hemorrhages with pale centers due to coagulated fibrin) Osler nodes (tender, raised, red lesions found on the hands and feet) Organ infarction (tissue death) Splinter hemorrhages (small red streaks under nails) Janeway lesions (non-tender, red macules/nodules on palms/soles – only a few millimeters wide) Regurgitation (blood leaks back through the insufficient valve despite it being closed) Valve unable to fulfill normal functions (valve insufficiency) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Aug 20, 2013, updated Feb 24, 2024 on www.thecalgaryguide.com