InsideSurgery Medical Information Blog

Details of surgical procedures, pathophysiology, signs and symptoms, and treatment of medical diseases,medical and surgical eponyms, and surgeons and surgery in the news

  • Home
  • Eponyms
  • Abbreviations
  • Terms of Use
  • Privacy Policy
  • Contact

Bacterial Endocarditis

March 13, 2013

Pathophysiology of Bacterial Endocarditis

bacterial endocarditis is:

1) formation of bacterial vegetative thombi on cardiac valves
2) most commonly involved valves in bacterial endocarditis are aortic and mitral in non-IV drug abusers; tricuspid in IV drug abusers
3) affected valves “decay” with rupture and subsequent congestive heart failure
4) significant morbidity and mortality in bacterial endocarditis also arise from detachment of vegetations with embolization to brain, kidneys, lungs, gastrointestinal tract, and spleen with infarction and abscess formation
5) can have an acute (Staphylococcus aureus, beta-hemolytic streptococcus, of S. pneumoniae) or subacute presentation

bacterial endocarditis

Vegetative lesions seen on cardiac valves (arrows) in bacterial endocarditis

Signs and Symptoms

1) fever
2) anorexia
3) weight loss
4) new onset heart murmurs
5) subungual hemorrhages
6) petechiae
7) clubbing of fingers
8) splenomegaly
9) dyspnea (due to PE or cardiac failure
10) neurologic deficits (due to CNS emboli0
11) Osler’s nodes (bluish red nodules on digits, palms, and soles
12) Janeway’s spots (small hemorrhages on palms and soles
13) Roth’s spots (whitish spots in retina)

Characteristic Test Findings

Laboratory

1) anemia
2) increased sed rate
3) circulating immune complexes
4) rheumatoid factor (50%)
5) increased C-reactive protein
6) microscopic hematuria

Echocardiography

7) used for diagnosis of lesions

Histology/Gross Pathology

1) vegetations in bacterial endocarditis are a mixture of bacteria, fibrin, and platelets
2) kidney shows focal embolic glomerulonephritis with immune complex deposition, causing a “flea-bitten” appearance
3) denuded endothelium at high pressure jets or low-pressure areas of cardiac defects is the first step in lesion propagation
4) virulent organisms can attach directly to bare areas

Associated Condtions

increased incidence in bacterial endocarditis in

1) rheumatic heart disease
2) congenital heart defects (patent ductus arteriosus, VSD, tetralogy of Fallot)
3) IV drug abuse
4) dental procedures
5) instrumentation of body orifices (endoscopy, catheter insertion)
6) elderly
7) diabetes
8) pregnancy
9) indwelling prostheses

Inheritance/Epidemiology

1) 6/100,000 in USA per year
2) mortality is 25-50% (with treatment)
3) 15% have negative blood cultures

Treatment

1) aggressive and prolonged antibiotic treatment (minimum 4 weeks)
2) surgical repair of deteriorating valve

Tips for USMLE

1) if a 72 year old diabetic man with mild aortic stenosis has a cystoscopy and 14 days later develops a low-grade feer, malaise, elevated sed rate, and weakness in his right hand, think bacterial endocarditis

Trackbacks

  1. Intracardiac Echocardiography May Improve Detection of Implantable Device-Related Endocarditis | Heart Rhythm Center says:
    March 30, 2013 at 2:59 pm

    […] Bacterial Endocarditis (insidesurgery.com) […]

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Categories

  • Acupuncture
  • Amputation Surgery
  • Anesthesia
  • Appendix Surgery
  • Articles
  • Bird Flu
  • BP Oil Spill Health Risks
  • Breast Surgery
  • Cancer
  • Cardiac Surgery
  • Cardiology
  • Case Reports
  • Clinical Trials – Published
  • Colon Surgery
  • Complementary and Alternative Medicine
  • Critical Care
  • Dental and Oral Surgery
  • Dermatology
  • Devices and Technology
  • Drug-Drug Interactions
  • Ebola
  • Endocrinology
  • Eye Surgery
  • For Professionals
  • Gallbladder Surgery
  • Gastroenterology
  • General
  • Grand Rounds
  • Hand Surgery
  • Head and Neck Surgery
  • Healthcare Law
  • Hematology
  • Hernia Surgery
  • Hip Surgery
  • History of Surgery and Medicine
  • Hyperbaric Oxygen
  • Infectious Disease
  • Interviews
  • Liver Surgery
  • Medical Eponym Bios
  • Medical Mnemonics
  • Medical News Wire
  • Medical Trivia
  • Medical Words and Abbreviations
  • Musings
  • Nanomedicine
  • Neck Surgery
  • Neurology
  • Nutrition
  • ObGyn Surgery
  • Oncology
  • Orthopedic surgery
  • Pancreas Surgery
  • Pediatric Surgery
  • Pediatrics
  • People
  • Pharmacology
  • Plastic Surgery
  • Pulmonology
  • Rectal Surgery
  • Rheumatology
  • Small Bowel Surgery
  • Spleen Surgery
  • Stomach Surgery
  • Surgery and Medicine Quotations
  • Surgical Procedure Videos
  • Surgpedia
  • Thoracic Surgery
  • Tip of the Day
  • Transplant Surgery
  • Trauma Surgery
  • Uncategorized
  • Urology Surgery
  • USMLE
  • Vascular Surgery

Archives

© 2019 InsideSurgery.comĀ® · All rights reserved.
This material may not be published, broadcast, rewritten, or redistributed without the express written consent of InsideSurgery.com.
Inside Surgery
  • Home
  • Eponyms
  • Abbreviations
  • Terms of Use
  • Privacy Policy
  • Contact