Infective Endocarditis Presentation PDF

ECHO: INFECTIVE ENDOCARDITIS SANJANA K INFECTIVE ENDOCARDITIS (IE) Microbial infection of the endothelial surface of the heart. It affects on : Valve leaflets Congenital defects Walls or chordae of the chambers Prosthetic v...

ECHO: INFECTIVE ENDOCARDITIS SANJANA K INFECTIVE ENDOCARDITIS (IE) Microbial infection of the endothelial surface of the heart. It affects on : Valve leaflets Congenital defects Walls or chordae of the chambers Prosthetic valves Conduits Grafts Pacing wires →Caused by S.aureus S.epidermis S. Bovis Enterococcus The clinical diagnosis of the IE is based upon a combination of features such as:  Positive blood cultures  Echocardiographic findings  Other clinical or laboratory criteria If left untreated it is generally fatal. MODIFIED DUKE CRITERIA Diagnostic criteria for IE MAJOR CRITERIA 1) Blood culture positive for typical microorganism (eg: Staphylococcus aureus , Enterococcus ) 2) Evidence of endocardial involvement with positive echocardiogram defined as the following: Presence of vegetation Abscess New partial dehiscence of prosthetic valve MINOR CRITERIA 1) Predisposing cardiac lesion 2) Intravenous drug use 3) Temperature > 38C 4) Embolic phenomena 5) Immunologic phenomena ( eg: glomerulonephritis) 6) Positive blood culture not meeting a major criterion. Definite IE – 2 major OR 1 major + 3 minor OR 5 minor criteria Possible IE – 1 major + 1 minor OR 3 minor criteria ROLE OF ECHO To detect the presence, localisation, mobility, shape and number of valvular vegetations. To detect the existence of periannular extension of the infection. To evaluate functional disturbances of the affected valves , especially the presence and the severity of valvular regurgitations. To identify the subjacent anatomy of the infected valves and any other concomitant affection. To determine the impact of valvular dysfunction: size and cardiac function- especially the LV and Pulmonary hypertension. To recognise the existence of other possible,less common findings: pericardial effusions ECHOCARDIOGRAPHY IN IE Several echocardiographic findings are typical of IE.  Vegetation  Periannular tissue destruction  Valve perforation  Valve dehiscence VEGETATIONS Vegetations are the hallmark of IE Defined as masses of irregular morphology adhered to valvular leaflets, endocardial surface, or to prosthetic intracardiac material. Vegetations usually occur on the lower pressure side of a valve. Vegetations can cause valvular regurgitations as well as stenosis. Large aortic vegetation  PERIANNULAR EXTENSION OF THE INFECTION Echocardiography plays a key role in the diagnosis of complications of the infection.  Most frequent anatomical complications of IE includes Valvular destruction like perforation, leaflets rupture,subvalvular mitral apparatus rupture, prosthetic dehiscence and perivalvular complications ( Abscess,psuedoaneurysms,and fistulas) Abscess – a thickening, nonhomogeneous perivalvular area with echodens or echolucent appearance  Pseudoaneurysm –A pulsatile, perivalvular, echofree space, with colour Doppler flow inside Fistula- A colour Doppler communication between two neighbouring cavities through a perforation VALVE PERFORATION It is a frequent complication of infective endocarditis. Patients with this complication have more incidence of heart failure and higher need of valvular substitution.  PROSTHETIC VALVE →Pts. Suspected of having IE with prosthetic valve should undergo TEE →Sensitivity of TEE for prosthetic valve is 86-94% with specificity of 88-99%. →Annulus is the most common initial site of infection. →Characters; Low incidence of vegetations. High incidence of perivalvular complications.  INTRACARDIAC DEVICE RELATED IE →Mostly seen in ICD than pacemaker. →Echo findings – Vegetations may attached to electrode leads, tricuspid leaflets, endocardial walls. →Test of choice – TEE. TRANSTHORACIC vs TRANSESOPHAGEAL ECHOCARDIOGRAPHY TTE is the initial diagnostic test for IE with intermediate risk patients. →It has ↓ resolution than TEE & can miss vegetations 10mm vegetations.  MCQ 1)