19. AIE SIE Causative high virulence pyogenic bacteria: Staphylococcus aureus (50-80%) low virulence pyogenic bacteria: α-hemolytic streptococcus viridans (50-90%) Preexisting Cardiac abnormal usually no, Normal valves or prosthetic heart valves rheumatic valvular disease (50-60%), congenital heart disease (20%), ventricular septa defect (15%), normal valves 15%. Vegetation big, soft, friable pus-like , yellow-gray masses; white thrombus containing large amount of polymorphous neutrophils relatively firm, friable, irregular or polyp-like masses; white thrombus containing less amount of polymorphous neutrophils Valves change severe acute purulent valvulitis: the valves undergo erosion, perforation or rupture; granulation tissue is absent or scarce. mild chronic purulent valvulitis: fibrous thickening, perforation (less common), with granulation tissue in the base of the vegetation Chordae change break off very common fibrous thickened, shortened, break off less common Embolism Embolic abscesses Septicemia （ hepatomegaly, splenomegaly, hemorrhage of skin, mucosa, positive blood cultures ） Ischemic infarct (spleen, kidneys and brain)
34. “ Echo should be done in all cases of suspected endocarditis.” (This is not all patients with fever or positive blood cultures). Circulation 1997; 95: 1686-1784
51. Predisposing Conditions Strom BL, Abrutyn E, Berlin JA, Kinman JL, Feldman RS, Stolley PD, et al. Ann Intern Med. 1998;129:761-9. IV drug users and nosocomial cases excluded.
52.
53. Infection Growth of vegetation by platelet-fibrin deposition yields a sanctuary for bacteria.
68. Anticoagulation “ If anticoagulation is indicated for another reason it should be continued. Anticoagulation does not prevent embolization due to IE.” ACC guidelines on Diagnosis and Management of Infective Endocarditis.
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71. Bayer AS, et al. Circ 98:25, 2936-48. 22/29 Dec 98
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78. Embolic Events: an Aggressive Approach Clinical Embolic Event (CNS or peripheral) CT/MR of Brain Small, ischemic infarcts & Mild neurologic impairment Vegetations present by echo Prompt Surgery Large or hemorrhagic infarct Observe Blaustein AS Card Clin 14:3,1996
92. “ The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish.” William Osler
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97. Use of Echo in Diagnosis of IE Bayer AS, et al. Circ 98:25, 2936-48. 22/29 Dec 98
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