Prepared by : Abdullah Mosluh Abdullah Academic No. :426810123

Bader Nasser Al-Msaed

1Infective ENDOCARDITIS

Definition infection of the endocardial surface of the

heart, which may include one or more heart valves, the mural endocardium, or a septal defect.

Infectious endothelial lesions Called Vegetation

Primarily complication of congenital heart disease

2Infective ENDOCARDITIS

pathogenesis

3Infective ENDOCARDITIS

pathogens cause infective endocarditis

Who is at high risk of infection by this organism? 4Infective ENDOCARDITIS

Clinical manifestationsymptomsConstitutionalSweating AnroxiaWeaknessChillWeight lossMyalgia Back pain

5Infective ENDOCARDITIS

DUKE CRITERIAMAJOR CRITERIA include :Microorganisms consistent with IE from persistently positive blood

cultures defined as: Two positive cultures of blood samples drawn >12 hours apart, or All of 3 or a majority of 4 separate cultures of blood (with first and

last sample drawn 1 hour apart) Coxiella burnetii detected by at least one positive blood culture or

antiphase I IgG antibody titer >1:800Evidence of endocardial involvement with positive echocardiogram

defined as Vegetation on valve

Abscess, ornew valvular regurgitation (worsening or changing of preexisting

murmur not sufficient)

6Infective ENDOCARDITIS

continueMinor criteria include:Predisposing factor: known cardiac lesion,

recreational drug injectionFever >38°CEvidence of embolism: arterial emboli, pulmonary

infarcts, Janeway lesions, conjunctival hemorrhageImmunological problems: glomerulonephritis,

Osler's nodes roth spot rheumatoid factor Positive blood culture (that doesn't meet a major

criterion) or serologic evidence of infection with organism consistent with IE but not satisfying major criterion

7Infective ENDOCARDITIS

The Roth Spot is a white-centered hemorrhage

8Infective ENDOCARDITIS

Osler Nodules Skin janeway lesion

9Infective ENDOCARDITIS

LABORATORY STUDIES & IMAGING Multiple blood cultures ESR& CRP↑ Leukocytosis, anemia & hematuria +ve rheumatoid factor ECHO

10Infective ENDOCARDITIS

TREATMENTAcutely ill persons

→ empirical antibiotic therapySubacute disease

→ wait results of blood culturesBactericidal antibiotic

→ 4 to 8 weeksIE ( viridans streptococci )

→ monotherapy penicillin G for 4 weeks

11Infective ENDOCARDITIS

Surgery will be indicated in the following conditions:

Unsuccessful medical treatment with persistant bacterimiaFungal endocarditisValve annulus or myocardial abscessRupture of valve leafletValvular insufficiency with acute or refractory

heart failureRecurrent serious embolic complicationsRefractory prosthetic valve disease

12Infective ENDOCARDITIS

Prosthetic cardiac valves

Previous IE Unrepaired cyanotic congenital

heart disease

Valvular lesions in posttransplant pt. Oral amoxicillin 50 mg/ kg ( 30 – 60 min )

Clindamycin or azithromycin ( allergic to β – lactam)

13Infective ENDOCARDITIS

14Infective ENDOCARDITIS