cardiovascular disorders
Infective Endocarditis
Key Points
Because the normal heart is relatively resistant to infection, endocarditis occurs mainly when there is a predisposing abnormality of the endocardium. Predisposing cardiac abnormalities include congenital heart defects, rheumatic valvular disease, bicuspid or calcific aortic valves, mitral valve prolapse, hypertrophic cardiomyopathy, prior endocarditis, and intracardiac devices. Local cardiac consequences include myocardial abscess, conduction system abnormalities, and sudden, severe valvular regurgitation. Systemic consequences include immune phenomena (eg, glomerulonephritis) and septic emboli, which may affect any organ put particularly the lungs (with right sided endocarditis), kidneys, spleen, central nervous system, skin, and retina (with left-sided endocarditis). Do blood cultures and diagnose using modified Duke or European Society of Cardiology clinical criteria. Treat with a prolonged course of antimicrobial therapy; surgery may be needed for mechanical complications or resistant organisms. Give antimicrobial prophylaxis for patients at high risk of an adverse outcome from infective endocarditis, including those with prosthetic heart valves or heart valve repair, previous infective endocarditis, certain congenital heart diseases, or who are heart transplant recipients with valvulopathy. 