Complications in Patients with Valvular Lesions Infective Endocarditis Heart Failure Dysrhythmias Pulmonary Hypertension Systemic Emboli Acute Rheumatic Fever

INFECTIVE ENDOCARDITIS PROF MARX

AETIOLOGY Microbial infection of cardiac structure eg. native or prosthetic valve THUS Damaged or abnormal heart valve Organisms Streptococcus viridans Staphylococcus aureus Other Brucella, Fungi

PATHOPHYSIOLOGY ( 1 ) Damaged endothelium - jet of blood Deposition of platelets and fibrin Colonization by bloodborne organisms VEGETATIONS FORMED

PATHOPHYSIOLOGY ( 2 ) Embolization eg. kidney, spleen, cerebral Immunological Complications - vasculitis, nephritis Destructive complications - perforation or disruption valves

CLINICAL FEATURES Prior to A/B theraphy - stuttering course leading to death Acute Infective Endocarditis Severe febrile disease Fast clinical and hemodynamic deterioration Normal valves with changing heart murmurs Embolic events, valve rupture

SUBACUTE INFECTIVE ENDOCARDITIS Cardiac abnormality eg. valve lesion Sudden change in murmurs General abnormalities fever, anaemia, night sweats Specific signs

POST OPERATIVE ENDOCARDITIS Unexplained fever after cardiac surgery Valve ring abses

INVESTIGATIONS Blood cultures- aseptic technique - 3 or more specimens Bloodcount- anaemia, ESR, leukositosis Compliment- C 3 c Echocardiographic- vegetations ECG and chest radiograph

MANAGEMENT General support measures Bacteriocidal antimicrobial drugs treat for weeks. IV appropriate A/B Treat any complications

PREVENTION Identify patients at risk - valvular lesions, congenital lesions Avoid or treat possible bacteremia Antibiotic prophylaxis