Endocarditis natural history, complications and prognosis

(Redirected from Endocarditis complications)
Jump to navigation Jump to search

Endocarditis Microchapters


Patient Information


Historical Perspective




Differentiating Infective Endocarditis from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications & Prognosis


Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings



Echocardiography and Ultrasound

CT scan


Other Imaging Findings

Other Diagnostic Studies


Medical Therapy


Primary Prevention

Secondary Prevention

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

Diagnosis and Follow-up

Medical Therapy


Case Studies

Case #1

Endocarditis natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides


Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Endocarditis natural history, complications and prognosis

CDC onEndocarditis natural history, complications and prognosis

Endocarditis natural history, complications and prognosis in the news

Blogs on Endocarditis natural history, complications and prognosis

to Hospitals Treating Endocarditis natural history, complications and prognosis

Risk calculators and risk factors for Endocarditis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]


If left untreated, patients with endocarditis may progress to develop congestive heart failure. Complications of endocarditis can occur as a result of the locally destructive effects of the infection. These complications include perforation of valve leaflets causing congestive heart failure, abscesses, and disruption of the heart's conduction system. Endocarditis may also cause embolization to the brain (causing a stroke), to the coronary artery (causing a heart attack), to the lung (causing pulmonary embolism), to the spleen (causing a splenic infarct), and to the kidney (causing a renal infarct). Prognosis of endocarditis is generally poor and the overall mortality rate for both native and prosthetic valve endocarditis ranges from 20-25%. The mortality rate for right-sided endocarditis in injection drug users is approximately 10%. The 5-year survival rate for native valve endocarditis is 70-80% and 50-80% for prosthetic valve endocarditis.

Natural History


Complications of infective endocarditis include:[1][2]


  1. Murmur
  2. A new aortic diastolic murmur suggests dilatation of the aortic annulus or eversion, rupture, or fenestration of an aortic leaflet
  3. The sudden onset of a loud mitral pansystolic murmur suggests rupture of chordae tendineae or fenestration of a mitral valve leaflet
  4. Congestive heart failure
  5. Cardiac rhythm disturbances including AV block
  6. Pericarditis (uncommon)


  1. Petechiae of the conjunctiva, oropharynx, skin, and legs
  2. Linear subungual splinter haemorrhages of the lower or middle nail bed
  3. Osler's nodes
  4. Janeway lesions


  1. Myalgias
  2. Arthralgias
  3. Arthritis
  4. Low back pain
  5. Rheumatoid factor is elevated in up to 50% of patients with endocarditis for >6 weeks
  6. Clubbing of fingers is present in < 15% of patients


  1. Petechial hemorrhages
  2. Flame-shaped hemorrhages
  3. Roth's spots
  4. Cotton-wool exudates in the retina


  1. Significant arterial emboli occur in 30%–50% of patients, causing the following:
  2. CNS emboli are common
  3. Coronary emboli, often asymptomatic, can cause myocardial infarction
  4. Pulmonary emboli are common in right-sided endocarditis, causing pulmonary infarcts or focal pneumonitis


  1. Splenomegaly is observed in 15%–30% of patients
  2. Splenic infarcts occur in up to 40% of patients
  3. Splenic abscesses occur in ~ 5% of patients


  1. Microscopic hematuria occurs in ~ 50% of patients
  2. Embolic renal infarction
  3. Diffuse membranoproliferative glomerulonephritis

Mycotic Aneurysms

Occur in any artery in 2%–8% of patients, causing the following:

  1. Pain or headache
  2. Pulsatile mass
  3. Fever
  4. Sudden expanding hematoma
  5. Signs of major blood loss


  1. Neurologic complications occur in 25%–40% of cases
  2. Strokes caused by cerebral embolisms in ~15% of cases, causing the following:
  3. Cerebral aneurysms occur in 1%–5% of cases, causing the following:
  4. Brain abscesses may occur in acute endocarditis caused by Staphylococcus aureus
  5. Seizures

Monitoring for Complications of Infectious Endocarditis

Among those patients at high risk, careful monitoring should be undertaken to detect the early development of complications such as:

  1. Valvular dysfunction, usual insufficiency of the mitral or aortic valves
  2. Myocardial or septal abscesses
  3. Congestive heart failure
  4. Metastatic infection
  5. Embolic phenomenon



  1. 1.0 1.1 1.2 Mylonakis E, Calderwood SB (2001). "Infective endocarditis in adults". N Engl J Med. 345 (18): 1318–30. doi:10.1056/NEJMra010082. PMID 11794152. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)
  2. 2.0 2.1 Baddour Larry M., Wilson Walter R., Bayer Arnold S., Fowler Vance G. Jr, Bolger Ann F., Levison Matthew E., Ferrieri Patricia, Gerber Michael A., Tani Lloyd Y., Gewitz Michael H., Tong David C., Steckelberg James M., Baltimore Robert S., Shulman Stanford T., Burns Jane C., Falace Donald A., Newburger Jane W., Pallasch Thomas J., Takahashi Masato, Taubert Kathryn A. (2005). "Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association-Executive Summary: Endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): 3167–84. PMID 15956145.

Template:WH Template:WS