TAILIEUCHUNG - Chapter 118. Infective Endocarditis (Part 4)

Cardiac Manifestations Although heart murmurs are usually indicative of the predisposing cardiac pathology rather than of endocarditis, valvular damage and ruptured chordae may result in new regurgitant murmurs. In acute endocarditis involving a normal valve, murmurs are heard on presentation in only 30–45% of patients but ultimately are detected in 85%. Congestive heart failure develops in 30–40% of patients; it is usually a consequence of valvular dysfunction but occasionally is due to endocarditis-associated myocarditis or an intracardiac fistula. Heart failure due to aortic valve dysfunction progresses more rapidly than does that due to mitral valve dysfunction. Extension of infection. | Chapter 118. Infective Endocarditis Part 4 Cardiac Manifestations Although heart murmurs are usually indicative of the predisposing cardiac pathology rather than of endocarditis valvular damage and ruptured chordae may result in new regurgitant murmurs. In acute endocarditis involving a normal valve murmurs are heard on presentation in only 30-45 of patients but ultimately are detected in 85 . Congestive heart failure develops in 30-40 of patients it is usually a consequence of valvular dysfunction but occasionally is due to endocarditis-associated myocarditis or an intracardiac fistula. Heart failure due to aortic valve dysfunction progresses more rapidly than does that due to mitral valve dysfunction. Extension of infection beyond valve leaflets into adjacent annular or myocardial tissue results in perivalvular abscesses which in turn may cause fistulae from the root of the aorta into cardiac chambers or between cardiac chambers with new murmurs. Abscesses may burrow from the aortic valve annulus through the epicardium causing pericarditis. Extension of infection into paravalvular tissue adjacent to either the right or the noncoronary cusp of the aortic valve may interrupt the conduction system in the upper interventricular septum leading to varying degrees of heart block. Although perivalvular abscesses arising from the mitral valve may potentially interrupt conduction pathways near the atrioventricular node or in the proximal bundle of His such interruption occurs infrequently. Emboli to a coronary artery may result in myocardial infarction nevertheless embolic transmural infarcts are rare. Noncardiac Manifestations The classic nonsuppurative peripheral manifestations of subacute endocarditis are related to the duration of infection and with early diagnosis and treatment have become infrequent. In contrast septic embolization mimicking some of these lesions subungual hemorrhage Osler s nodes is common in patients with acute S. aureus endocarditis Fig. 118-2 . .

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• Significant regurgitation
• Non bacterial thrombotic endocarditis
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• Transthoracic echocardiogram
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