文档介绍：Update on Infective Endocarditis
Larry Baddour, MD
University of Tennessee
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Pathogenesis
Disruption of the endocardial layer as plication of abnormal blood flow associated with underlying cardiac defect
Bacterium-endothelium interaction with bacterial attachment and invasion of endothelial cells
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Epidemiology
Underlying valvular abnormality predisposing to infective endocarditis
rheumatic fever mon cause in the past
mitral valve prolapse currently represents the mon underlying cardiac abnormality
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mitral valve prolapse
risk for infective ednocarditis is 5x-8x
mitral regurgitation increases the risk
leaflet redundancy with myxomatous degeneration is a frequent finding
age <20 , female predominate age >20 , male accounts for 60% age >50 , male accounts for 68%
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Mitral Valve Prolapse and Infective Endocarditis
Male
Female
Number of cases
Rev Infect Dis 1986;8:117-137
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Coagulase-negative i
can produce native-valve endocarditis in mitral valve prolapse
usually subacute, difficult to diagnose, and disregarded as a contaminant
delay in diagnosis and treatment may account for the plications
myocardial abscess formation
valvular insufficiency requiring valve surgery
death
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Prosthetic Heart Valve
positive blood culture in hospitalized patients with underlying prosthetic valves can be a harbinger of endocarditis
43% patients with ial bacteremia or fungemia had prosthetic valve infection
a plication
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IV Drug Use
Recurrent
Polymicrobial
Staph aureus accounts for the majority of cases of endocarditis
tricuspid valve, either alone or bination, us most often infected
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Predisposing Factors Polymicrobial Infective Endocarditis
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Polymicrobial Infective Endocarditis clinical features
IV drug use is the predominant risk factor
younger age (mean years)
2/3 were male
right-sided cardiac involvement in > 60%
i more frequent than S. aureus
1/3 of patients died
mortality r