Skip to main content Accessibility help
×
×
Home
  • Print publication year: 2008
  • Online publication date: December 2009

1 - Infective Endocarditis

from Part I - Systems
    • By Jorge A. Fernandez, Assistant Professor of Clinical Emergency Medicine, Keck School of Medicine, University of Southern California; Director of Medical Student Education, Department of Emergency Medicine, Los Angeles County–USC Medical Center, Los Angeles, CA, Stuart P. Swadron, Associate Professor of Emergency Medicine, Keck School of Medicine, University of Southern California; Residency Program Director, Los Angeles County–USC Medical Center, Los Angeles, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Publisher: Cambridge University Press
  • DOI: https://doi.org/10.1017/CBO9780511547454.002
  • pp 3-8

Summary

INTRODUCTION

Cardiac infections are classified by the affected site: endocardium, myocardium, or pericardium. Although the terms pericarditis, myocarditis, and endocarditis refer to inflammation in general, most cases are secondary to infectious disease.

EPIDEMIOLOGY AND PATHOPHYSIOLOGY

Infective endocarditis (IE) affects the endocardium, though inflammation may damage the cardiac valves themselves, as well as the underlying myocardium. IE more commonly affects the left side of the heart, more commonly affects males (2:1), and increases in incidence with age. The pathogenic agent is usually bacterial but may also be fungal, rickettsial, or protozoan, particularly in immunocompromised patients.

Infective endocarditis occurs when circulating pathogens adhere to the endocardium in areas of turbulent flow, particularly around cardiac valves. Host susceptibility is an integral part of the pathophysiology. Several decades ago, rheumatic fever was the most common cause of valvular lesions, and bacterial adherence to these damaged valves could occur in any age group. Now, congenital heart disease and degenerative valvular disease are the most common predisposing factors to IE, in children and the elderly, respectively. An increasing percentage of cases arise from prosthetic heart valves, which have enhanced susceptibility to infection.

When bacteremia is frequent, adherence to the endocardium may occur even in the absence of a valvular lesion, and intravenous drug users, immunocompromised patients, and those with indwelling vascular catheters or poor dental hygiene are at greater risk for IE.

Recommend this book

Email your librarian or administrator to recommend adding this book to your organisation's collection.

Emergency Management of Infectious Diseases
  • Online ISBN: 9780511547454
  • Book DOI: https://doi.org/10.1017/CBO9780511547454
Please enter your name
Please enter a valid email address
Who would you like to send this to *
×
REFERENCES
Alexiou, C, Langley, S M, Stafford, H, et al. Surgery for active culture-positive endocarditis: determinants of early and late outcome. Ann Thorac Surg 2000;69(5):1448–54.
Barbaro, G, Fisher, S D, Gaincaspro, G, Lipshultz, S E. HIV-associated cardiovascular complications: a new challenge for emergency physicians. Am J Emerg Med 2001 Nov;19(7):566–74.
Cabell, C H, Jollis, J G, Peterson, G E, et al. Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med 2002;162(1):90–4.
Calder, K K, Severyn, F A. Surgical emergencies in the intravenous drug user. Emerg Med Clin North Am 2003;21(4):1089–116.
Olaison, L, Pettersson, G. Current best practices and guidelines indications for surgical intervention in infective endocarditis. Infect Dis Clin North Am 2002;16(2):453–75.
Pawsat, D E, Lee, J Y. Inflammatory disorders for the heart. Pericarditis, myocarditis, and endocarditis. Emerg Med Clin North Am 1998 Aug;16(3):665–81.
Samet, J H, Shevitz, A, Fowle, J. Hospitalization decision in febrile intravenous drug users. Am J Med 1990;89(1):53–7.
Sandre, R M, Shafran, S D. Infective endocarditis: review of 135 cases over 9 years. Clin Infect Dis 1996;22(2):276–86.
Sexton, D J, Spelman, D. Current best practices and guidelines. Assessment and management of complications in infective endocarditis. Infect Dis Clin North Am 2002;16(2):507–21.
Towns, M L, Reller, L B. Diagnostic methods current best practices and guidelines for isolation of bacteria and fungi in infective endocarditis. Infect Dis Clin North Am 2002;16(2):363–76.
Wilson, L E, Thomas, D L, Astemborski, J, et al. Prospective study of infective endocarditis among injection drug users. J Infect Dis 2002;185(12):1761–6.
Young, G P, Hedges, J R, Dixon, L, et al. Inability to validate a predictive score for infective endocarditis in intravenous drug users. J Emerg Med 1993:11(1):1–7.
ADDITIONAL READINGS
Fernandez J, Swadron S. Infective endocarditis. In: Stone, S, Slavin, S, eds, Infectious diseases. Burr Ridge, IL: McGraw-Hill, 2006:255–87.
Mylonakis, E, Calderwood, S B. Infective endocarditis in adults. N Engl J Med 2001;345(18):1318–30.