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1 - Infective Endocarditis

from Part I - Systems

Published online by Cambridge University Press:  15 December 2009

By
Jorge A. Fernandez  and
Stuart P. Swadron
Edited by
Rachel L. Chin
Jorge A. Fernandez
Affiliation:
Assistant Professor of Clinical Emergency Medicine, Keck School of Medicine, University of Southern California; Director of Medical Student Education, Department of Emergency Medicine, Los Angeles County–USC Medical Center, Los Angeles, CA
Stuart P. Swadron
Affiliation:
Associate Professor of Emergency Medicine, Keck School of Medicine, University of Southern California; Residency Program Director, Los Angeles County–USC Medical Center, Los Angeles, CA
Rachel L. Chin
Affiliation:
University of California, San Francisco
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Summary

INTRODUCTION

Cardiac infections are classified by the affected site: endocardium, myocardium, or pericardium. Although the terms pericarditis, myocarditis, and endocarditis refer to inflammation in general, most cases are secondary to infectious disease.

EPIDEMIOLOGY AND PATHOPHYSIOLOGY

Infective endocarditis (IE) affects the endocardium, though inflammation may damage the cardiac valves themselves, as well as the underlying myocardium. IE more commonly affects the left side of the heart, more commonly affects males (2:1), and increases in incidence with age. The pathogenic agent is usually bacterial but may also be fungal, rickettsial, or protozoan, particularly in immunocompromised patients.

Infective endocarditis occurs when circulating pathogens adhere to the endocardium in areas of turbulent flow, particularly around cardiac valves. Host susceptibility is an integral part of the pathophysiology. Several decades ago, rheumatic fever was the most common cause of valvular lesions, and bacterial adherence to these damaged valves could occur in any age group. Now, congenital heart disease and degenerative valvular disease are the most common predisposing factors to IE, in children and the elderly, respectively. An increasing percentage of cases arise from prosthetic heart valves, which have enhanced susceptibility to infection.

When bacteremia is frequent, adherence to the endocardium may occur even in the absence of a valvular lesion, and intravenous drug users, immunocompromised patients, and those with indwelling vascular catheters or poor dental hygiene are at greater risk for IE.

Type
Chapter
Information
Emergency Management of Infectious Diseases , pp. 3 - 8
Publisher: Cambridge University Press
Print publication year: 2008

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References

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  • Infective Endocarditis
    • By Jorge A. Fernandez, Assistant Professor of Clinical Emergency Medicine, Keck School of Medicine, University of Southern California; Director of Medical Student Education, Department of Emergency Medicine, Los Angeles County–USC Medical Center, Los Angeles, CA, Stuart P. Swadron, Associate Professor of Emergency Medicine, Keck School of Medicine, University of Southern California; Residency Program Director, Los Angeles County–USC Medical Center, Los Angeles, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.002
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Save book to Dropbox

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  • Infective Endocarditis
    • By Jorge A. Fernandez, Assistant Professor of Clinical Emergency Medicine, Keck School of Medicine, University of Southern California; Director of Medical Student Education, Department of Emergency Medicine, Los Angeles County–USC Medical Center, Los Angeles, CA, Stuart P. Swadron, Associate Professor of Emergency Medicine, Keck School of Medicine, University of Southern California; Residency Program Director, Los Angeles County–USC Medical Center, Los Angeles, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.002
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Infective Endocarditis
    • By Jorge A. Fernandez, Assistant Professor of Clinical Emergency Medicine, Keck School of Medicine, University of Southern California; Director of Medical Student Education, Department of Emergency Medicine, Los Angeles County–USC Medical Center, Los Angeles, CA, Stuart P. Swadron, Associate Professor of Emergency Medicine, Keck School of Medicine, University of Southern California; Residency Program Director, Los Angeles County–USC Medical Center, Los Angeles, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.002
Available formats
×