Pathology of Endocarditis Peter B. Baker, M.D. Clinical Professor, Pathology

Cardiopulmonary Block Objective  Describe the pathologic features of bacterial and nonbacterial endocarditis

Objectives List the features of acute and subacute infectious endocarditis Identify predisposing factors for infectious endocarditis Describe the pathologic features and list the morphologic complications of infectious endocarditis. Be able to identify 4 conditions associated with sterile vegetations on cardiac valves

Infectious Endocarditis Handout X.B.1.a Acute endocarditis Short duration Virulent organism Large vegetations Prominent tissue destruction Previously normal valve Subacute endocarditis Longer duration Low virulence organism Small vegetations Less tissue destruction Previously abnormal valve

Infectious Endocarditis Handout X.B.1.b-c Predisposing factors intracardiac shunts IV drug abuse valvular disease immunosuppression prosthetic valves Pathogenesis endothelial damage fibrin thrombi organisms in the blood

Acute Bacterial Endocarditis

Bacterial Endocarditis Vegetation Valve

Bacterial Endocarditis

Valve Vegetation

Infectious Endocarditis Handout X.B.1.d  Complications rupture of chordae tendineae contiguous spread thromboembolism septic emboli with abscesses valvular regurgitation

Floppy Mitral Valve with Bacterial Endocarditis Floppy mitral valve with bacterial endocarditis

Aortic Valve with Bacterial endocarditis Aortic Valve with Leaflet Perforation

Mitral Valve with Bacterial Endocarditis Mitral Valve with Ruptured Chordae

Mitral Valve with Perivalvular Abscess Abscess

Septic Embolus in Coronary Artery

Sterile Endocardial Vegetations Handout XII.B Etiologies 1. Nonbacterial thrombotic endocarditis (marantic endocarditis) 2. Systemic lupus (Libman-Sacks endocarditis) 3. Acute rheumatic fever 4. Intra-cardiac devices (leads, catheters)

Nonbacterial Thrombotic Endocarditis

Histology of Nonbacterial Thrombotic Endocarditis Nonbacterial Thrombotic Endocarditis Valve Leaflet Vegetation

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