Pdf from an epidemiologic point of view, rightsided infective endocarditis. Rightsided infective endocarditis rsie accounts for 510% of all cases of infective endocarditis ie, and is predominantly encountered in the injecting drug user idu population, where hiv and hcv coinfections often coexist. Approximately 10% of infective endocarditis ie involves the right side of the heart with the majority of these cases occurring in intravenous drug users. A 31yearold man with prior intravenous drug use presented with. Right sided infective endocarditis is strongly associated with intravenous drug use, and 90% of right sided endocarditis involves the tricuspid valve. Iv drug abusers have a much higher incidence of right sided endocarditis about 30 to 70%. Microsoft powerpoint 09 lecture 9 infective endocarditis compatibility mode. Infective endocarditis is defined by a focus of infection within the heart and is a feared disease across the field of cardiology. Definitions a microbial infection of a cardiac valve or the endocardium caused by bacteria, fungi, or chlamydia often categorized as acute or subacute based on the rapidity of the clinical course alternatively described by type of risk factor e. Rightsided infective endocarditis rsie can be classified into three epidemiological groups.
Prevention of infective endocarditis high risk prosthetic valve complex congenital heart disease pi d diiprevious endocarditis cardiac transplantation with valvulopathy. Infective endocarditis at the presbyterian hospital in new york. Infective endocarditis occurs most often on the left side eg, mitral or aortic valve. Infective endocarditis is rare, with a yearly incidence of about 310 per 100 000 people. The cause of rightsided infective endocarditis in the present case may have been the repeated drip infusions at the clinic or the uncontrollable diabetic mellitus. Isolated right sided involvement is well detected by tte in those cases a toe isnt necessary. Rightsided infective endocarditis rie is far less common than. Sixty years after its initial description, right sided infective endocarditis rsie still poses a challenge to all medical practitioners. Tricuspid valve leaflet repair and augmentation for infective. Right sided native valve infective endocarditis ie refers to ie involving the tricuspid or pulmonic valve. Symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cell count. Surgical treatment for medically uncontrollable progressive rightsided endocarditis has been reported to be associated with high mortality and morbidity. Intravenous drug use has increased substantially over the past decade, with heroin abuse more than doubling. Cardiac murmurs and systemic emboli are usually absent in rsie, whereas pulmonary embolism and its.
A free powerpoint ppt presentation displayed as a flash slide show on id. Despite optimal care, mortality approaches 30% at 1 year. Surgical treatment of rightsided infective endocarditis. Original article rightsided infective endocarditis. Background despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. Rheumatic heart disease and infective endocarditis free download as powerpoint presentation. The challenges posed by infective endocarditis are significant. In western countries, rie occurs predominantly in intravenous drug users idus although patients with. Rightsided native valve infective endocarditis ie refers to ie involving the tricuspid or pulmonic valve.
These lesions are not specific for infective endocarditis and more commonly are the result of traumatic injuries. This apparent paradox is explained by a progressive evolution in risk factors. About 10 to 20% of cases are right sided tricuspid or pulmonic valve. Rightsided infective endocarditis rie is commonly due to staphylococcus aureus and often involves the tricuspid valve tv. Start studying infective endocarditisie learn vocabulary, terms, and more with flashcards, games, and other study tools. Nosocomial endocarditis is a form of healthcare associated endocarditis in which the infective organism is acquired during stay in a hospital and it is usually secondary to presence of intravenous catheters, total parenteral nutritionlines, pacemaker, etc.
Ppt infective endocarditis powerpoint presentation free. The valves of the heart do not receive any dedicated blood supply. Despite improvements in health care, the incidence of infective endocarditis has not decreased over the past decades. Risk factors for rightsided ie include injection drug use, presence of a cardiac implantable. Classically, ivdu has been thought to affect right sided valves. Classically, ivdu has been thought to affect rightsided valves. Chapter 83 infective endocarditis and valvular disease. The pathogenesis of rsie is still not well understood. It generally occurs inpatients with altered and abnormal heartarchitecture, in combination with exposure tobacteria through trauma and other.
Right sided infective endocarditis rsie accounts for only 510% of cases of infective endocarditis ie 1, 2, the majority of which involves the tricuspid valve and occurs especially among injecting drug users idus and where intravenous lines and wires e. Endocarditis is most frequently infective in origin, and the definition has been expanded to include infection of intracardiac prosthetic material such. Studies1,2 and guidelines3 have helped clinicians identify and manage patients with ie. Infective endocarditis ie carries high morbidity and mortality and most frequently affects the left side of the heart. Tricuspid valve leaflet repair and augmentation for. Infective endocarditis intravenous drug abuse risk is 2 5% per pt. Rightsided infective endocarditis rsie accounts for 510% of all. A total of 127 patients 95% had tricuspid valve and 7 patients 5% pulmonary valve infective endocarditis. Rightsided ie was comprehensively analyzed based on recent 5. New criteria for diagnosis of infective endocarditis. Ivdu can cause right sided lesions tricuspid valve pulmonary complications.
Rightsided infective endocarditis secondary to intravenous drug. Infective endocarditis is the microbial infection of heart valve. Clinical features and prognosis of rie occurring in nondrug users are not well known. Chapter 83 infective endocarditis and valvular disease episode overview. Daoud, md, faaaai acute rheumatic fever multisystem disorder of children jones criteria major, minor and supporting evidence of streptoccoal infection managemet acutely antibiotics, bed rest, aspirin, corticosteroids, secondary prvention chronic rheumatic heart disease endocarditis fever and changing murmurs. Endocarditis is traditionally defined as an inflammation of the endothelial lining of the heart which usually results in the formation of vegetations platelet and fibrin aggregates which can enlarge to several centimeters in diameter.
However, in recent times a more variable presentation of ivduassociated ie has been reported. Clinical features of right sided infective endocarditis occurring in nondrug users right sided infective endocarditis rie occurs predominantly in intravenous drug users in western countries, and it has a relatively good prognosis. Valvular insufficiency, embolic events and abscess. Contemporary outcomes of operations for tricuspid valve. Rightsided infective endocarditis is strongly associated with intravenous drug use, and 90% of rightsided endocarditis involves the tricuspid valve. Rightsided endocarditis in the nondrug addict postgraduate. Google scholar see all references the purpose of this report is to document a case of rightsided endocarditis occurring on a native valve due to a actinomycetemcomitans and to stress the value of twodimensional echocardiographic. We hypothesized that these ghosts of leads could be associated with the diagnosis of cardiac devicerelated infective endocarditis cdrie.
Update on infective endocarditis powerpoint ppt presentation. Patients are less likely to present with classical ie signs of a new murmur and peripheral stigmata, are more frequently immunocompromised and often have significant social difficulties. Additionally, its clinical presentation, treatment, and outcome differ from the. Native valve right sided infective endocarditis sciencedirect. Over the past five decades, the incidence of intravenous drug use ivdu associated infective endocarditis ie has been on the rise in north america. Portal of entry, implanted foreign material, and repaired congenital heart defects were the main predisposing risk factors. Invasiveness of left and rightsided infective endocarditis.
The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life. Rsie differs from leftsided infective endocarditis in more than just the location of the involved cardiac valve. The usual manifestations are persistent fever, bacteraemia. Clinical features of rightsided infective endocarditis. In most cases 82% the infection was located in the tricuspid valve. Isolated rightsided valvular endocarditis in nonintravenous drug.
Infective endocarditis is the property of its rightful owner. About 10 to 20% of cases are rightsided tricuspid or pulmonic valve. During the period of the opioid epidemic, tricuspidrelated endocarditis rates have increased, while the incidence of surgery for tricuspid endocarditis has increased as much as fivefold. Injection drug userelated infective endocarditis hospitalizations have similarly increased over the same period. Jan 15, 2014 musci m, siniawski h, pasic m, grauhan o, weng y, meyer r, yankah ca, hetzer r. Right sided infective endocarditis rie is commonly due to staphylococcus aureus and often involves the tricuspid valve tv. Infective endocarditis is an infection of the inner surface of the heart, usually the valves. Complications may include backward blood flow in the heart, the heart struggling to pump a sufficient blood to meet the bodys needs heart failure, abnormal electrical. Infective endocarditis acute toxic presentation progressive valve. In general, symptoms and complications arise from involvement of the.
Definition of infective endocarditis infective endocarditis, a serious infection ofthe endocardium of the heart, particularly theheart valves, is associated with a high degreeof illness and death. Portal of entry, implanted foreign material, and repaired congenital heart defects were. Rightsided infective endocarditis presenting with purpuric. Endocarditis 10 polymicrobial infective endocarditis clinical features. Rightsided infective endocarditis rie is far less common than leftsided infective endocarditis lie accounting for 5%10% of all cases of infective endocarditis ie 1. Infective endocarditis guidelines on prevention, diagnosis. Andrew bridgeman, mbchb, bsc, and umberto benedetto, md, phd infective endocarditis ie is a serious condition associated with high mortality. A complicated case of serratia marcescens infective endocarditis in the era of the current opioid epidemic. Cases with rie or leftsided infective endocarditis lie defined by the vegetation site. Give three examples of immunologic sequelae of infective endocarditis 4. Vegetation size on the rightsided valves was much smaller than those beyond.
Surgical treatment of rightsided active infective endocarditis with or without involvement of the left heart. Surgical treatment of rightsided infective endocarditis the journal. Infective endocarditis caused by slowgrowing, fastidious, gramnegative bacteria. List 5 common bacteria responsible for infective endocarditis 3. Compared with what have been reported that the mean vegetation size was 1. Ppt infective endocarditis powerpoint presentation. Infective endocarditis cardiovascular disorders merck. Furthermore, ventricular septal perforation caused by right sided endocarditis has not been reported. Ppt infective endocarditis powerpoint presentation free to download id. The presenting clinical features of right and left sided endocarditis are different. They have different clinical presentations, diagnostic findings, and prognoses. Rightsided infective endocarditis usually presents with fever, persistent bacteraemia and septic emboli to the lungs. Iv drug abusers have a much higher incidence of rightsided endocarditis about 30 to 70%. Background the echocardiographic appearance of residual floating masses in the right atrium.
Background the echocardiographic appearance of residual floating masses in the right. Its clinical presentation and treatment differ from those of leftsided endocarditis,14 and its. Ventricular septal perforation caused by rightsided. Native valve right sided infective endocarditis request pdf. Rightsided infective endocarditis and pulmonary infiltrates. Clinical features of rightsided infective endocarditis occurring in. Definition infective endocarditis ie, a microbial infection of the heart valves or other endocardial tissue, usually is associated with an underlying cardiac defect, primarily by bacteria. In patients with right sided endocarditis either the tricuspid or pulmonic valve, particularly injection drug users with tricuspid valve endocarditis, only 35% will have an audible murmur. While most patients with right sided endocarditis will have systolic murmurs, the murmur is clearly pathologic in a minority of cases. Objectives we sought to determine the incidence, diagnostic value, and outcome of intracardiac masses observed by echocardiography after device removal. Diagnosis of cardiac devicerelated infective endocarditis. Here, we report a case of a patient with a known history of ivdu who presented with. Invasiveness of left and right sided infective endocarditis.
Infective endocarditis ie is a disease that is continually changing, with new high risk patients, new diagnostic procedures, the involvement of new microorganisms, and new therapeutic methods. It is frequently acquired in the health care setting, and more than onehalf of cases now occur in patients without known heart disease. Pdf clinical classification and prognosis of isolated rightsided. Infective endocarditis ie has been increasingly reported, however, little is available regarding recent development of rightsided ie. The search terms included right heart endocarditis, rightsided. Infective endocarditis vegetations arrows due to viridans streptococcal endocarditis involving the mitral valve. Characteristics of isolated rightsided endocarditis in patients without a. Epidemiological data reveal a rising incidence attributable to the global surge in the number of intravenous drug users and the increased use of central vascular catheters and implantable cardiac devices. Give three examples of vascular sequelae of infective endocarditis 5. Computed tomographic scans of a patient with right middle cerebral artery infarction resulting from infective endocarditis.
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