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Definition and types: & ·
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Infective Endocarditis • Infection of the endocardial surface of the heart (usually involves
the cusps of the valves).
1. Acute endocarditis: Caused by Staphylococcus aureus (highly
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isvirulent) & Occurs on a normal heart valve. If untreated fatal in less

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than 6 weeks
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20th Nov 2022
di 2. Subacute endocarditis: Caused by less virulent organisms, such as
Streptococcus viridians and Enterococcus Occurs on damaged heart
valves If untreated, takes much longer than 6 weeks to cause death

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value
damages is -
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viridans streptococcus

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↳ S epidermidis

trumbus
bacteria
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Enterococcus
 1st problem: I, 185

Septic emboli
- Migration of the vegetation
1. Splinter hemorrhage (nail) S. aureus -
2. Janeway lesion (skin): painless not in all
body & Tricuspid
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3. Septic emboli: liver, spleen and brain. #valve
Right sided
endocarditis:
Pulmonary embolism

2nd problem: valve

insufficiency ( regurgitation)
3rd problem: Immune complexes formation

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APeX left sternal border • Osler node: painful skin lesion immune
• Mitral/tricuspid regurgitation:
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• Roth spot (eye) Ag-Ab
holosystolic murmur.
RE It • Glomerulonephritis
• Aortic/pulmonary regurgitation: Implex
decrescendo diastolic murmur. -
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• Heart failure: End-result of regurgitation
• Paravalvular abscess: AV block. most common

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 Diagnostic criteria (Duke criteria)
4th : inflammatory reaction (cytokines)
• Fever 1. 2 Major
• Fatigue, chills and rigor M(V= 80 100
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2. 1 major + 3 minor
• Anemia of chronic diseases “normocytic anemia” ( IL6 > secrete 3. 5 minors
hepcidin > Iron mobilization to bone marrow )
b haemoglobin

Microbiology
(1999 * Investigations
• Most common cause of native valve endocarditis is Streptococcus
viridans.
Other causes of native: Staphylococcus species & Enterococci. • CBC: Normocytic normochromic anemia
• Most common cause of early-onset (<60 days) prosthetic valve • Echo: vegetation
endocarditis is Staphylococcus epidermidis (coagulase -) then aureus. • ECG: AV block (paravalvular abscess)
• Most common cause of late-onset (>60 days) prosthetic valve
endocarditis is Streptococci. • Blood culture endocarditis (1 S
• IV drug users (tricuspids endocarditis): Staphylococcal aureus. then • ESR, Rheumatoid factor: High, may be positive.
Enterococci and Streptococci. Fungi (mostly Candida) and gram-negative • Urinalysis: hematuria (glomerulonephritis)
rods (mostly Pseudomonas) are less common causes.
• Colon cancer: Streptococcus bovis
• GU/GI procedure: Enterococci
 3
Blood culture Surgical treatment indications
• Three sets of blood culture should be drawn before initiation of
treatment. 1. Acute heart failure due to valvular damage
• Negative culture doesn’t exclude endocarditis, may be fastidious 2. Left-sided infective endocarditis with highly resistant organisms (including
gram-negative organisms “ HACEK” (Haemophilus, Actinobacillus, MRSA).
Cardiobacterium, Eikenella, and Kingella).
3. Infective endocarditis complicated by heart block or intracardiac abscess
• After drawing the blood samples for blood culture > start empiric
treatment of endocarditis t
4. Persistent bacteremia or fevers lasting 5 to 7 days after antibiotic initiation

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• Empiric treatment: Vancomycin (MRSA coverage) + Aminoglycoside ( 5. Recurrent infection in those with prosthetic valves
Gram negative bacteria ) until blood culture results appear.
• Treatment duration: 4-6 weeks of antibiotics.

Prophylaxis of endocarditis Prophylaxis of endocarditis

Indications Qualification procedures
• Amoxicillin or Clindamycin for patient with specific heart diseases to 1. Dental procedures involving manipulation of gingival mucosa or
prevent endocarditis. periapical region of teeth (extractions, implants, periodontal surgery,
1. Prosthetic heart valves (including mechanical, bioprosthetic, and cleaning when bleeding expected).
transcatheter valves). 2. Procedures involving biopsy or incision of respiratory mucosa.
2. History of infective endocarditis
3. Procedures involving infected skin or musculoskeletal tissue.
3. Congenital heart disease:
A. Unrepaired cyanotic congenital heart disease USD
B. Repaired congenital heart disease, with prosthetic material, during Note: Do NOT give antibiotics for endocarditis prophylaxis for:
first 6 months after procedure 1. Native mitral valve prolapse/stenosis
4. Cardiac transplant with valvulopathy 2. Routine GI (endoscopy) or GU (cystoscopy) procedures
 Infective
endocarditis
MCQs
• The type of endocarditis most commonly found in patients who are intravenous drug abusers is?
a. Staphylococcus aureus infection of the tricuspid valve
b. S.aureus infection of the mitral valve
c Haemolytic streptococcal infection of the tricuspid valve
d. Hemolytic streptococcal infection of the mitral valve
e. Pseudomonas aeruginosa infection of the pulmonic valve

• Eye manifestation in infective endocarditis : Roth spot

• Cause of death in malta fever : infective endocarditis

• IV drug user complaining of scenario of infective endocarditis , blood gram stain reveals G+ bacteria in cluster , what is
treatment of choice :
Vancomycin (approved by dr. waleed )
Answer: E (A wide variety of diseases are associated with
• Clinical features in infective endocarditis include all of the following, except: splenomegaly, or enlargement of the ... Such as in
a. Appearnace of new murmur or change in the quantiy of eisting murmur subacute bacterial endocarditis or infectious
b. Fever mononucleosis ... http://emedicine.medscape.com/article/
c. CHF 206208-overview)
d. Skin and eye lesions
e. No splenomegaly

• All the following cardiac lesions are associated with high risk of infective endocarditis Except.
a- VSD
b- combined mitral valve disease
c- aortis stenosis
d- Atrial septal defect
e- Aortic regurgitation

• ORGANISM RESPOSIBLE OF SUBACUTE ENDOCARDITIS one is true

a)streptococcus pyogenes
b)B haemolytic streptoccous
c)streptococcus viridians
d)stafyllococcus aures
e)H pylori