Endocarditis

Puls: Caused by Arthritis

Clinic

• Inflammation of the inner layer of endocardium, which usually involves the heart valves.
• Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or the surfaces of intracardiac devices.
• Endocarditis is characterized by lesions, known as vegetations, which is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells.
• In the subacute form of infective endocarditis, the vegetation may also include a center of granulomatous tissue, which may fibrose or calcify.

Sign / Symptoms

• Fu-like feeling, Fever, Chills, Sweating, Malaise, Weakness, Anorexia, Weight loss,
• Splenomegaly
• Cardiac murmur
• Heart failure
• Petechia (red spots on the skin)
• Osler's nodes (subcutaneous nodules found on hands and feet)
• Janeway lesions (nodular lesions on palms and soles),
• Roth's spots (retinal hemorrhages)

Infective endocarditis

• Infective endocarditis usually involve the valves.
• Symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cells.
• Complications: Valvular insufficiency, Heart failure, Stroke, Kidney failure.
• Causation: Typically a bacterial (Streptococci or Staphylococci) and less commonly a fungal infection.

Nonbacterial thrombotic endocarditis

• NBTE is most commonly found on previously undamaged valves.
• Opposed to infective endocarditis, the vegetations in NBTE are small, sterile, and tend to aggregate along the edges of the valve or the cusps.
• Unlike infective endocarditis, NBTE does not cause an inflammation response from the body.
• NBTE usually occurs during a hypercoagulable state such as system-wide bacterial infection, or pregnancy, though it is also sometimes seen in patients with venous catheters.
• NBTE may also occur in patients with cancers, particularly mucinous adenocarcinoma where Trousseau syndrome can be encountered.
• Typically NBTE does not cause many problems on its own, but parts of the vegetations may break off and embolize to the heart or brain, or they may serve as a focus where bacteria can lodge, thus causing infective endocarditis.

Libman–Sacks endocarditis

• It occurs more often in patients with lupus erythematosus and is thought to be due to the deposition of immune complexes.
• Like NBTE, Libman-Sacks endocarditis involves small vegetations, while infective endocarditis is composed of large vegetations.
• These immune complexes precipitate an inflammation reaction, which helps to differentiate it from NBTE.
• Also unlike NBTE, Libman-Sacks endocarditis does not seem to have a preferred location of deposition and may form on the undersurfaces of the valves or even on the endocardium.

Miasms

• CXB: A known cause of viral endocarditis is enterovirus, esp coxsackie B2.
• CMV
• HCV

Related disease

Endocardial fibroelastosis