1. INFECTIVE ENDOCARDITIS
Jayasree.B
Second year MBBS(4th sem)
Pondicherry Institute of Medical Sciences

2. Definition of Infective Endocarditis:
Microbial infection of heart valves or mural endocardium,
Leading to formation of vegetations composed of thrombotic debris and organisms,
associated with destruction of underlying cardiac tissues.

3. Vegetation: Platlet + Fibrin = Damaged vascular endothelium
When organisms adheres and grows on it then it becomes infective vegetation.

4. Types of vegetations RHD IE NBTE LSE Small,Firm, Friable
Large, bluky, irregular
Small friable
Medium sized flat verrucous
Along the lines of closure
Valve cusps and mural endocardium
Both surface of valves involved

5. RHD
Infective Endocarditis
Non bacterial thrombotic endocarditis
Libman sac endocarditis

6. Classification Main a)Native valve IE b)Prosthetic valve IE
Additionally:
a)IV Drug abuse IE
b)Nosocomial IE

7. Native Valve IE Acute IE Subacute IE Site Normal valves Damaged valves
Duration
Days to weeks
(aggressive)
Weeks to months
(indolent)
Organisms
Staph. aureus
Group B streptococci
Streptococcus viridans
Enterococci
Coagulase –ve Staph.
Lesions
Invasive and suppurative
Less severe
Clinical features
Fever, Chills, Weakness
Splenomegaly, Clubbing, Petechiae

8. Prosthetic valve IE 10%-30% in developed countries Early: Late:
<60 days of surgery
Complications of surgery
CoNS
Late:
>60 days
Later infection
Streptococci

9. Causative Organisms On native and previously damaged valve.
Because in Prosthetic heart valves
Streptococcus viridans
Staphylococcus epidermidis

10. Culture negative endocarditis
On previously normal heart valve:
HACEK group:
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
10% No microorganism in blood culture:
Anibiotic treatment before blood culture
Embedded inside large vegetations
Staphylococcus aureus
Culture negative endocarditis

11. Predisposing factors Conditions that lead to transient bacterimea
IV drug abusers
Conditions that lead to transient bacterimea
Underlying heart disease:
RHD , Mitral valve prolapse
Conditions impairing host defence.
Periodontal infections
Genito urinary tract infections

12. Pathophysiology Routes Entry of bacteria into blood stream BACTERAEMIA
On normal heart valve:
Staphylococcus aureus
Entry of bacteria into blood stream BACTERAEMIA
On previously damaged native heart valve:
Streptococcus viridans
Prosthetic heart valve:
Staphylococcus epidermidis
Reach heart internal surface
Implants on heart valve or mural endocardium

13. Grows and proliferates in large numbers inside
Mature vegetation occurs
Fibrin + Platelets + Microorganisms + inflammatory cells

14. Breaks and forms EMBOLUS which is infective
Spreads and causes:
Stroke
Cerebral hemorrhage
Aneurysms

15. Lack of blood Supply to the heart valve
Why the vegetations are only confined to valves??????
Lack of blood Supply to the heart valve

16. Clinical Manifestations
Fever
If spreads:
SEPSIS!
INFECTION
Chills
Leukocytosis

17. Infective vegetation breaks off
Left sided heart:
Brain, Kidney, Spleen
Right sided heart:
Lung PE
Infective vegetation breaks off
EMBOLUS
When reaches Peripheral vessels:
Oslers node
Splinter hemorrhage
Janeway lesions
Roth spots

18. Valvular abnormalities
Decreased cardiac output
Murmurs
Valvular abnormalities
Dysarrethmias

19. Splinter Hemorrhage Tiny bleeding points in the nail bed
and hyponchium of the nail unit
Due to peripheral vascular embolus
on the nail bed
small amount of bleeding occurs
at the grooves of nail bed
Bleeding is trapped by the
overlying nail plate
Due to its linear construction
the blood assumes
a straight line appearance

20. Painful More specific Painful and erythematous nodules
Located on the pulp of finger and toes

21. Janeway lesions
NOT
Painful
Hemorrhagic macular or nodular lesions on the palm or soles
Not painful
Microabscess caused by the septic embolus that deposit bacteria.

22. Roth spots A red spot (caused by hemorrhage)
With a pale white center(fibrin platelet plug)
Seen also in leukemia diabetes HIV

23. Clubbing Clubbing refers to swelling in the tip
of the digit that results in loss of
the normal angle seen between the
nail and the nail bed
The fingertips appear broader
and rounder .

24. THANK YOU!