Infective Endocarditis PPT | Guidelines Infective Endocarditis | Infective Bacterial Endocarditis | Infective Endocarditis Diagnosis | Infective Endocarditis Emedicine | Infective Endocarditis Symptoms: SlideWorld Medical PPT Search Engine

Infective Endocarditis

Rating :

Rate It:

Send This

Download

Comment

Favourite

more

Notes

Show Notes

Slide 1 :

Infective Endocarditis A. Rüçhan Akar ( Ankara University, School of Medicine) April-2003 Contributions to: Rakar@medicine.ankara.edu.tr

Slide 2 :

“Bacterial endocarditis is one of the few infectious diseases that almost always result in death unless treated” Child JS. Cardiology Clinics 14(3),327-343 Aug 1996

Slide 3 :

“Today, endocarditis is as common or more common than ever before, but it has taken on new clinical forms” Crawford MH Cardiology Clinics 14(3), Aug 1996

Slide 4 :

Historical Note first description of endocarditis- Lazaere Reviere (1646) Major RH. Bull Hist Med 17:351, 1945 first comprehensive clinical and pathologic description- William Osler (1885) Gulstonian Lectures to the Royal College of Physicians, London

Slide 5 :

Infective Endocarditis (IE) microbial infection of the endothelial surface of the heart mortality rate of IE declined from 100% to 5-10%

Slide 6 :

Vegetation mass of platelets fibrin micro-organisms inflammatory cells

Slide 7 :

Predisposing Risk Factors prosthetic cardiac valves (PVE) 20% IV drug users mitral valve prolapse 35% rheumatic degenerative congenital 15% asymetric septal hypertrophy immunosupressed 10-15%

Slide 8 :

Symptoms usually nonspecific, and constitutional High degree of suspicion is required

Slide 9 :

Clinical Manifestations “multi-system disease” FAME Fever Anaemia heart Murmur Embolic phenomena

Slide 10 :

Symptoms and Signs fever, chills, sweats 90% heart murmurs 85% enlargement of the spleen 25-60% anorexia, weight loss, malaise arthralgias, myalgias, low back pain 44% systemic emboli congestive heart failure renal insufficiency

Slide 11 :

Peripheral Stigmata of IE Janeway lesions 10% small erythematous or hemorrhagic macular non-tender lesions on the palms and soles Roth’s spots 5% retinal haemorrhages with pale centres Splinter or subungual haemorrhages 15% dark red, linear streaks in the nail bed of the fingers or toes Osler’s nodes 10-25% small, tender subcutaneous nodules within the skin of finger or toe pads and thenar and hypothenar eminences

Slide 12 :

Splinter or subungual haemorrhages 15% dark red, linear streaks in the nail bed of the fingers or toes

Slide 13 :

Roth’s spots 5% retinal haemorrhages with pale centres

Slide 14 :

Osler’s nodes 10-25% small, tender subcutaneous nodules within the skin of finger or toe pads and thenar and hypothenar eminences

Slide 15 :

Osler’s (Austrian triad) endocarditis pneumonia meningitis alcoholic, elderly, diabetes Strep. Pneumonia (most common) Penicillin or vancomycin

Slide 16 :

IE of native valves (NVE) streptococci 50-70% alpha haemolytic S. viridans staphylococci 25% enterococci 10% fastidious gram-negative coccobacilli

Slide 17 :

fastidious gram-negative coccobacilli so-called HACEK group Haemophilus species Actinobacillus actinomycetemcomitans Cardiobacterium hominis Eikenella Kingella

Slide 18 :

PROSTHETIC VALVE ENDOCARDITIS (PVE) 1.4-3.1% in one year

Slide 19 :

Slide 20 :

Prosthetic Valve Endocarditis (PVE) early (within 60 days) perioperative contamination S. Epidermidis 30-40 % S. Aureus 14 % Gram-negative 20 % Diphtheroids 12% Fungi 10 % late transient bacteraemia (dental, GI, GU) Strep. Viridans 25-30% S. Epidermidis 25 % S. Aureus 10 %

Slide 21 :

Pathology of PVE extension beyond the valve ring annulus and periannular tissue mitral-aortic intravalvular fibrosa ring abscesses, septal abscesses fistulous tracts dehiscence of the prosthesis paravalvular regurgitation

Slide 22 :

Empirical Therapy for PVE Ampicillin Vancomycin Gentamycin

Slide 23 :

Risk of Endocarditis Mechanical vs Bioprosthesis the initial months after valve implantation mechanical > bioprosthetic valves after 12 months bioprostheses > mechanical valves

Slide 24 :

Infective Endocarditis IV Drug Users

Slide 25 :

Microbiology of Endocarditis IV Drug Users staphylococcus aureus 50-60% streptococci 10% enterococci 10% pseudomonas, serratia 10-15% Fungi (Candida) 5% Culture-negative 3%

Slide 26 :

Infective Endocarditis IV Drug Users tricuspid valve 44 % mitral valve 43 % aortic valve 40 % pulmonic valve 3 %

Slide 27 :

Aortic valve vegetation

Slide 28 :

Aortic Regurgitant jet

Slide 29 :

Absolute Indications for Surgery congestive heart failure unstable prosthesis uncontrolled infection: persistent bacteraemia ineffective anti-microbial therapy fungal endocarditis relapse after optimal therapy (prosthetic valves)

Slide 30 :

Relative Indications for Surgery perivalvular extension staphylococcus aureus endocarditis (aortic, mitral, prosthetic valve) relapse after optimal antimicrobial therapy (native valves) culture-negative endocarditis with persistent unexplained fever ( > 10 days) large (> 10 mm) vegetations

Slide 31 :

Surgical Techniques Homograft in the aortic or mitral positions Valve composite graft for the aortic root Primary repair or patching of valves and septa Cardiac transplantation Time to operate: severe valve regurgitation that impairs cardiac function

Slide 32 :

Prognosis NVE mortality Medical 50% Surgery 15% PVE Surgery 25%

Slide 33 :

Relatively High Risk of Infective Endocarditis Pre-existing Cardiac Disorders prosthetic heart valves previous infective endocarditis cyanotic congenital heart disease patent ductus arteriosus aortic regurgitation aortic stenosis mitral regurgitation mitral stenosis and regurgitation ventricular septal defect coarctation of the aorta surgically repaired intracardiac lesion with residual haemodynamic abnormality surgically constructed systemic-pulmonary shunts Dajani, A. S., Bisno, A. L., Chung, K. S, et al.: Recommendations of the American Heart Association. JAMA 264:2919, 1990.

Slide 34 :

Intermediate Risk of Infective Endocarditis mitral valve prolapse with regurgitation (murmur) pure mitral stenosis tricuspid valve disease pulmonary stenosis asymmetrical septal hypertrophy bicuspid aortic valve or calcific aortic sclerosis with minimal haemodynamic abnormality degenerative valvular disease in elderly surgically repaired intracardiac lesions with minimal or no haemodynamic abnormality, less than 6 months after operation Dajani, A. S., Bisno, A. L., Chung, K. S, et al.: Recommendations of the American Heart Association. JAMA 264:2919, 1990.

Slide 35 :

dental procedures known to induce gingival or mucosal bleeding, including professional cleaning and scaling tonsillectomy or adenoidectomy surgery involving gastrointestinal or upper respiratory mucosa rigid bronchoscopy sclerotherapy for oesophageal varices oesophageal dilatation Dajani, A. S., Bisno, A. L., Chung, K. S, et al.: Recommendations of the American Heart Association. JAMA 264:2919, 1990. Procedures for which prophylaxis against endocarditis is considered (I)

Slide 36 :

Procedures for which prophylaxis against endocarditis is considered (II) gallbladder surgery cytoscopy, urethral dilatation uretheral catheterization if urinary infection is present urinary tract surgery, including prostate surgery incision and drainage of infected tissue vaginal hysterectomy vaginal delivery complicated by infection Dajani, A. S., Bisno, A. L., Chung, K. S, et al.: Recommendations of the American Heart Association. JAMA 264:2919, 1990.

Slide 37 :

Prophylaxis Not Recommended (I) dental procedures not likely to cause bleeding, such as adjustment of orthodontic appliances and simple fillings above the gum line intraoral injection or local anaesthetic shedding of primary teeth tympanostomy tube insertion endotracheal tube insertion flexible bronchoscopy cardiac catheterisation

Slide 38 :

Prophylaxis Not Recommended (II) gastrointestinal endoscopy, with or without biopsy Caesarean section in the absence of infection: urethral catheterisation dilatation and curettage uncomplicated vaginal delivery therapeutic abortion insertion or removal of intrauterine device sterilization procedures Laparoscopy

There is no comments now for this Slide.

Post a comment

Post Comment on Twitter Post Comment on SlideWorld

Comments:

Subscribe to follow-up comments

1 Favorites

diab1 alhaddad, favourited this 1 Months ago.

	SlidesOnline 1 Years ago. Category: other

Tags:	other

899 Views, 1 favourite
mitral valve prolapse with regurgitation (murmur); pure mitral stenosis; tricuspid valve disease; p more mitral valve prolapse with regurgitation (murmur); pure mitral stenosis; tricuspid valve disease; pulmonary stenosis; asymmetrical septal hypertrophy … less

SWINE Flu

Why do women live longer then men? Humor

History of Medicine

Yoga and Medicine

How to be a Successful Interventional Fellow size 50 MB

Cardiac Pathology

Hypertension: New Concepts, Guidelines, and Clinical Management

Diabetes Pathology