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Potentially life-threatening emergency
Acute bacterial endocarditis
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Potentially life-threatening emergency

Acute bacterial endocarditis

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Contributors: Neil Mendoza MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Bacterial endocarditis is an infection of the endocardial surface of the heart. The most common structures of the heart affected are the heart valves. The term "acute" endocarditis is a clinical description of the rapidity of symptoms and is opposed to "subacute" endocarditis. Patients present acutely ill with fever and historically would die shortly after presentation. They may have signs of heart failure or present with embolic phenomena including stroke or Janeway lesions (painless erythematous macules that occur on the palms and soles). Certain causative organisms of endocarditis that typically present acutely and with a more fulminant course include Staphylococcus aureus and Streptococcus pyogenes. The viridans streptococci are classically associated with subacute progression of symptoms. However, it is known that certain organisms, including the enterococci, can present both acutely and subacutely. For this reason, clinicians now prefer to describe endocarditis by the etiologic agent responsible.

Patients at increased risk of this infection include intravenous drug users and patients with a predisposing heart condition including the presence of cardiac devices or prosthetic valves. Infection, including Candida infection, can occur after open heart surgery or valve replacement via catheter (TAVR).

Patients typically have fever. Cardiac murmur is usually present. On physical exam, there may be conjunctival hemorrhages, splinter hemorrhages, Janeway lesions, Osler nodes (tender, erythematous nodules that appear suddenly on the finger or toe pads), or Roth spots (pale lesions with surrounding hemorrhage seen in the fundi, with an ivory or white center surrounded by a red halo).

Imaging may reveal septic pulmonary infarcts, mycotic aneurysms, and stroke. Laboratory testing may reveal anemia, leukocytosis, elevated ESR, positive rheumatoid factor, hematuria, and red blood cell (RBC) casts in urine.

The diagnosis of endocarditis can be made by isolating the responsible organism in blood culture and by visualizing the valvular vegetation on echocardiography. Treatment is with prolonged antibiotics and sometimes with surgery to remove the source of infection.

Related topic: Prosthetic Valve Endocarditis

Codes

ICD10CM:
I33.0 – Acute and subacute infective endocarditis

SNOMEDCT:
111286002  – Acute bacterial endocarditis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • There are a variety of infections that can result in bacteremia without necessarily being associated with seeding of the heart valves. Cellulitis, septic joint, cholecystitis or cholangitis, and intraabdominal abscess are a few such infections.
  • Cardiac devices such as pacemakers or left ventricular assist devices or other intravascular devices such as PICC lines or ports can become infected and lead to prolonged bacteremia without the heart valves themselves necessarily being infected.
  • Some conditions are associated with noninfectious valvular vegetations – systemic lupus erythematosus, Lambl's excrescences.
  • Some conditions can be associated with skin findings that could appear similarly to those seen in endocarditis – cholesterol emboli, left ventricular thrombus with subsequent embolization, embolization of deep vein thrombosis in cases of right-to-left cardiac shunts, vasculitis.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 12/02/2016
Last Updated: 01/15/2019
Copyright © 2019 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Acute bacterial endocarditis
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Acute bacterial endocarditis : Chills, Fatigue, Fever, Night sweats, Dyspnea, ESR elevated, WBC elevated
Clinical image of Acute bacterial endocarditis
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