Endocarditis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
[[Endocarditis complications|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]], disruption of the heart's conduction system, and 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]]). | |||
==Complications== | ==Complications== | ||
Revision as of 12:43, 23 September 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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, disruption of the heart's conduction system, and 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).
Complications
A complete list of complications of infective endocarditis include the following:
Cardiac
- Murmur
- A new aortic diastolic murmur suggests dilatation of the aortic annulus or eversion, rupture, or fenestration of an aortic leaflet
- The sudden onset of a loud mitral pansystolic murmur suggests rupture of chorda tendineae or fenestration of a mitral valve leaflet
- Congestive heart failure
- Cardiac rhythm disturbances including AV block
- Occasionally, pericarditis
Cutaneous
- Petechiae of the conjunctiva, oropharynx, skin, and legs
- Linear subungual splinter haemorrhages of the lower or middle nail bed
- Oslers nodes
- Janeway lesions
Musculoskeletal
- Myalgias
- Arthralgias
- Arthritis
- Low back pain
- Rheumatoid factor is elevated in up to 50% of patients with endocarditis for > 6 wk
- Clubbing of fingers is present in < 15% of patients
Ocular
- Petechial hemorrhages
- Flame-shaped hemorrhages
- Roth's spots,
- Cotton-wool exudates in the retina
Embolic
- Significant arterial emboli occur in 30%–50% of patients, causing the following:
- Stroke
- Monocular blindness
- Acute abdominal pain, ileus, and melena
- Pain and gangrene in the extremities
- CNS emboli are common
- Coronary emboli, often asymptomatic, can cause myocardial infarction
- Pulmonary emboli common in right-sided endocarditis, causing pulmonary infarcts or focal pneumonitis
Splenic
- Splenomegaly is observed in 15%–30% of patients
- Splenic infarcts occur in up to 40% of patients
- Splenic abscesses occur in ~ 5% of patients
Renal
- Microscopic hematuria occurs in ~ 50% of patients
- Embolic renal infarction
- Diffuse membranoproliferative glomerulonephritis
Mycotic Aneurysms
Occur in any artery in 2%–8% of patients, causing the following:
- Pain or headache
- Pulsatile mass
- Fever
- Sudden expanding hematoma
- Signs of major blood loss
Neurologic
- Neurologic complications occur in 25%–40% of cases
- Strokes caused by cerebral embolisms in ~ 15% of cases, causing the following:
- Altered level of consciousness
- Seizures
- Fluctuating focal neurologic signs
- Cerebral aneurysms occur in 1%–5% of cases, causing the following:
- Headache
- Focal signs
- Acute intracerebral or subarachnoid hemorrhage caused by rupture
- Mild meningeal irritation resulting from slow leakage
- Brain abscesses may occur in acute endocarditis caused by Staphylococcus aureus
- 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:
- Valvular dysfunction, usually insufficiency of the mitral or aortic valves;
- Myocardial or septal abscesses
- Congestive heart failure
- Metastatic infection
- Embolic phenomenon
Prognosis
Surgical Outcomes
Operative mortality is 15 - 20%. The development of an infection of a prosthetic valve during operation for native valve endocarditis is 4%, it is higher (12 - 16%) if active endocarditis is present at the time of the surgery. Late survival at 5 years for native valve endocarditis is 70 - 80% and for prosthetic valve endocarditis is 50 - 80%.[1]
References
- ↑ 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.