Infection of endocardial surface, most commonly valves.
Causes
- • Staph aureus (acute, MRSA in IVDU)
- • Viridans streptococci (subacute)
- • Enterococci
- • HACEK
- • Candida (prosthetic, IVDU)
Risk factors
- • Prosthetic valve
- • Rheumatic/degenerative valve disease
- • IVDU (tricuspid)
- • Congenital heart disease
- • Recent dental/GU procedure
Clinical features
- • Fever, night sweats, weight loss
- • New murmur
- • Emboli (stroke, splenic infarct)
- • Immune phenomena (Osler nodes, Roth spots)
Investigations
- • 3 sets blood cultures before antibiotics
- • TTE then TOE (higher sensitivity)
- • CRP/ESR, CBC, U&E
- • Urinalysis (microscopic haematuria)
Diagnosis
- • Modified Duke criteria: 2 major, or 1 major + 3 minor, or 5 minor
Management
- • Empirical: vancomycin + gentamicin (add rifampicin if prosthetic)
- • Native strep viridans: penicillin/amoxicillin ± gent 2–4 wk
- • Staph aureus: flucloxacillin (vanc if MRSA) 4–6 wk
- • Surgery: HF, uncontrolled infection, prosthetic dehiscence, large vegetation with embolic events
Complications
- • HF, embolic events, abscess, mycotic aneurysm, glomerulonephritis
Prevention
- • Prophylaxis for high-risk (prosthetic valve, prior IE, cyanotic CHD) before dental procedures
Clinical pearls
- • Culture-negative causes: Coxiella, Bartonella, Brucella, fastidious
References
- • ESC 2023 IE
- • AHA 2015 IE
Related in WardRound
Educational — verify locally.
