TAILIEUCHUNG - Chapter 118. Infective Endocarditis (Part 7)

Experts favor echocardiographic evaluation of all patients with a clinical diagnosis of endocarditis; however, the test should not be used to screen patients with a low probability of endocarditis (., patients with unexplained fever). An American Heart Association approach to the use of echocardiography for evaluation of patients with suspected endocarditis is illustrated in Fig. 118-4. A negative TEE when endocarditis is likely does not exclude the diagnosis but rather warrants repetition of the study in 7–10 days. Figure 118-4 The diagnostic use of transesophageal and transtracheal echocardiography (TEE and TTE, respectively). . | Chapter 118. Infective Endocarditis Part 7 Experts favor echocardiographic evaluation of all patients with a clinical diagnosis of endocarditis however the test should not be used to screen patients with a low probability of endocarditis . patients with unexplained fever . An American Heart Association approach to the use of echocardiography for evaluation of patients with suspected endocarditis is illustrated in Fig. 118-4. A negative TEE when endocarditis is likely does not exclude the diagnosis but rather warrants repetition of the study in 7-10 days. Figure 118-4 The diagnostic use of transesophageal and transtracheal echocardiography TEE and TTE respectively . f High initial patient risk for endocarditis as listed in Table 118-8 or evidence of intracardiac complications new regurgitant murmur new electrocardiographic conduction changes or congestive heart failure . High-risk echocardiographic features include large vegetations valve insufficiency paravalvular infection or ventricular dysfunction. Rx indicates initiation of antibiotic therapy. Reproduced with permission from Diagnosis and Management of Infective Endocarditis and Its Complications Circulation 1998 98 2936-2948. 1998 American Heart Association. Other Studies Many laboratory studies that are not diagnostic . complete blood count creatinine determination liver function tests chest radiography and electrocardiography are nevertheless important in the management of patients with endocarditis. The erythrocyte sedimentation rate C-reactive protein level and circulating immune complex titer are commonly increased in endocarditis Table 118-2 . Cardiac catheterization is useful primarily to assess coronary artery patency in older individuals who are to undergo surgery for endocarditis. Infective Endocarditis Treatment Antimicrobial Therapy It is difficult to eradicate bacteria from the avascular vegetation in infective endocarditis because this site is relatively deficient in host defenses and .

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• Significant regurgitation
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• Lung cancer
• Deep vein thrombosis
• Transthoracic echocardiogram
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