The inflammation of the inner layer of the heart, the endocardium.
It usually involves the heart valves, but may also involve the septum, the chordae tendinae, the mural endocardium, or the surfaces of intracardiac devices.
Can be infective or non-infective.
Most often bacterial.
Risk Factors for Infectious Endocarditis
Congenital heart disease
Rheumatic heart disease
Previous infective endocarditis
Abnormal Cardiac Anatomy
75% of people who develop endocarditis have abnormal cardiac anatomy. This incldes congenitcal heart defects such as bicuspid aortic valve, mitral valve prolapse, rheumatic heart disease, or artificial heart valves.
25% of people who develop endocarditis have normal cardiac anatomy, but many of these in this group are IV drug users.
Pathophysiology of Endocarditis
Bacteremia + Abnormal Structure = Endocarditis
Stasis along the side of the valves allows bacteria to settle.
Staphylococcus and streptococcus account for >80%
Complications of Infective Endocarditis
Mycotic aneurysms (from bacteria)
Heart failure (cardiac / valvular dysfunction)
Symptoms of Infective Endocarditis
Heart failure symptoms
Back pain (spleen)
Physical Signs of Endocarditis
Endocarditis does not always have physical exam signs, in fact, it often does not. Be clinically suspicious of endocarditis.
Splenomegaly - 11%
Splinter hemorrhages (nails) - 8%
Conjunctival hemorrhage - 5%
Janeway lesions (painless) - 5%
Osler's nodes (painful) - 3%
Roth's spots (in retina) - 2%
Treatment of Infective Endocarditis
It is extremely important to get blood cultures and an ID consultation.
Native infective endocarditis you treat with cidal drug therapy, echo monitoring, and heart failure therapy.
Prosthetic infective endocarditis you need an immediate surgical consultation and surgery along with cidal drug therapy.