Endocarditis

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Summary 1) Fundamentals of Pathology by Hussain Sattar

Endocarditis is the inflammation of the endocardium that lines the surface of cardiac valves.

Pathophysiology 2) Wikipedia

Diagram of infected area in endocarditis (MedicaLook)

Since the valves of the heart do not receive any dedicated blood supply, defensive immune mechanisms (such as white blood cells) cannot directly reach the valves via the bloodstream. If an organism (such as bacteria) attaches to a valve surface and forms a vegetation, the host immune response is blunted. The lack of blood supply to the valves also has implications on treatment, since drugs also have difficulty reaching the infected valve. Normally, blood flows smoothly past these valves. If they have been damaged (from rheumatic fever, for example) the risk of bacteria attachment is increased.

Causes 3) Fundamentals of Pathology by Hussain Sattar

  • Commonly bacterial  Streptococcus viridans, Staphylococcus aureus, Staphylococcus epidermis, Streptococcus bovis

Symptoms 4) Fundamentals of Pathology by Hussain Sattar

  • Fever
  • Murmurs
  • Janeway lesions  erythematous nontender lesions on palms and soles
  • Osier nodes  tender lesions on fingers or toes
  • Splinter hemorrhages
  • Anemia of Chronic Disease

Echocardiogram – Arrow points to the vegetation due to infection on the tricuspid valve. (Black Poppy’s)

Diagnosis 5)Fundamentals of Pathology by Hussain Sattar6)Rapid Review Pathology by Edward Goljan

  • Blood Cultures  positive with causative agent
  • CBC  mild anemia, neutrophilic leukocytosis and monocytosis 
  • Transesophageal echocardiogram  detects lesions on valves

Treatment 7) Rapid Review Pathology by Edward Goljan

  • Initial Treatment is directed at the most likely organism.
  • Antibiotic after identification of the pathogen.

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