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Difference between revisions of "Heart valves"
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→Infective endocarditis
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==Infective endocarditis== | ==Infective endocarditis== | ||
*Abbreviated ''IE''. | |||
===General=== | ===General=== | ||
*Infection of the endocardium - often involves the valves (which are covered by endocardium). | *Infection of the endocardium - often involves the valves (which are covered by endocardium). | ||
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====Organisms==== | ====Organisms==== | ||
Particular organisms are associated with particular clinical scenarios: | Particular organisms are associated with particular clinical scenarios: | ||
*IV drug | *IV drug users = ''Staphylococcus aureus''.<ref name=Ref_PCPBoD8_298>{{Ref PCPBoD8|298}}</ref> | ||
*No risk factors/normal valve = ''Streptococcus viridans''. | *No risk factors/normal valve = ''Streptococcus viridans''. | ||
*Prosthetic valves = ''Staphylococcus epidermidis''.<ref name=pmid19660339>{{Cite journal | last1 = Alonso-Valle | first1 = H. | last2 = Fariñas-Alvarez | first2 = C. | last3 = García-Palomo | first3 = JD. | last4 = Bernal | first4 = JM. | last5 = Martín-Durán | first5 = R. | last6 = Gutiérrez Díez | first6 = JF. | last7 = Revuelta | first7 = JM. | last8 = Fariñas | first8 = MC. | title = Clinical course and predictors of death in prosthetic valve endocarditis over a 20-year period. | journal = J Thorac Cardiovasc Surg | volume = 139 | issue = 4 | pages = 887-93 | month = Apr | year = 2010 | doi = 10.1016/j.jtcvs.2009.05.042 | PMID = 19660339 }}</ref> | *Prosthetic valves = ''Staphylococcus epidermidis''.<ref name=pmid19660339>{{Cite journal | last1 = Alonso-Valle | first1 = H. | last2 = Fariñas-Alvarez | first2 = C. | last3 = García-Palomo | first3 = JD. | last4 = Bernal | first4 = JM. | last5 = Martín-Durán | first5 = R. | last6 = Gutiérrez Díez | first6 = JF. | last7 = Revuelta | first7 = JM. | last8 = Fariñas | first8 = MC. | title = Clinical course and predictors of death in prosthetic valve endocarditis over a 20-year period. | journal = J Thorac Cardiovasc Surg | volume = 139 | issue = 4 | pages = 887-93 | month = Apr | year = 2010 | doi = 10.1016/j.jtcvs.2009.05.042 | PMID = 19660339 }}</ref> | ||
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Most common organism overall: | Most common organism overall: | ||
*''Staphylococcus aureus''.<ref name=pmid12092480>{{Cite journal | last1 = Petti | first1 = CA. | last2 = Fowler | first2 = VG. | title = Staphylococcus aureus bacteremia and endocarditis. | journal = Infect Dis Clin North Am | volume = 16 | issue = 2 | pages = 413-35, x-xi | month = Jun | year = 2002 | doi = | PMID = 12092480 }}</ref> | *''Staphylococcus aureus''.<ref name=pmid12092480>{{Cite journal | last1 = Petti | first1 = CA. | last2 = Fowler | first2 = VG. | title = Staphylococcus aureus bacteremia and endocarditis. | journal = Infect Dis Clin North Am | volume = 16 | issue = 2 | pages = 413-35, x-xi | month = Jun | year = 2002 | doi = | PMID = 12092480 }}</ref> | ||
Less common organisms causing ''IE'' are known as ''HASEK group'': | |||
*'''''H'''aemophilus'' (''Haemophilus parainfluenzae'', ''Haemophilus aphrophilus'', ''Haemophilus paraphrophilus''). | |||
*'''''A'''ctinobacillus'' (''Actinobacillus actinomycetemcomitans'', ''Aggregatibacter aphrophilus''<ref>{{cite journal|pmid=16957111 | doi=10.1099/ijs.0.64207-0}}</ref>'') | |||
*'''''C'''ardiobacterium hominis. | |||
*'''''E'''ikenella corrodens''. | |||
*'''''K'''ingella'' (''Kingella kingae''). | |||
====Clinical==== | ====Clinical==== | ||
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**Cardiac involvement - vegetation. | **Cardiac involvement - vegetation. | ||
**+/-Febrile. | **+/-Febrile. | ||
Subdivided into: | |||
#Acute IE. | |||
#*Classically due to ''Staphylococcus aureus''. | |||
#Subacute IE. | |||
#*Classically due to ''Streptococcus viridans''. | |||
===Gross=== | ===Gross=== | ||
Location: | Location: | ||
*Left sided (mitral, aortic) more common than right sided (pulmonic, tricuspid). | *Left sided (mitral, aortic) more common than right sided (pulmonic, tricuspid). | ||
**This is reversed in IV drug users.<ref name=pmid16401952>{{Cite journal | last1 = Mathura | first1 = KC. | last2 = Thapa | first2 = N. | last3 = Rauniyar | first3 = A. | last4 = Magar | first4 = A. | last5 = Gurubacharya | first5 = DL. | last6 = Karki | first6 = DB. | title = Injection drug use and tricuspid valve endocarditis. | journal = Kathmandu Univ Med J (KUMJ) | volume = 3 | issue = 1 | pages = 84-6 | month = | year = | doi = | PMID = 16401952 }}</ref> | **This is reversed in IV drug users.<ref name=Ref_PCPBoD8_298>{{Ref PCPBoD8|298}}</ref><ref name=pmid16401952>{{Cite journal | last1 = Mathura | first1 = KC. | last2 = Thapa | first2 = N. | last3 = Rauniyar | first3 = A. | last4 = Magar | first4 = A. | last5 = Gurubacharya | first5 = DL. | last6 = Karki | first6 = DB. | title = Injection drug use and tricuspid valve endocarditis. | journal = Kathmandu Univ Med J (KUMJ) | volume = 3 | issue = 1 | pages = 84-6 | month = | year = | doi = | PMID = 16401952 }}</ref> | ||
*+/-Valvular destruction. | |||
**More common in acute IE. | |||
===Microscopic=== | ===Microscopic=== | ||