Endocarditis

Etiology

  • 80% staph, strep
  • Other less common organisms HACEK, Coxiella, T Whiplei, fungal

Risk Factors

  • IVDU
  • HIV
  • Hemodialysis
  • Prior endocarditis
  • Unrepaired cyanotic congenital heart dz
  • Prosthetic valve
  • Acquired valvular heart dz (e.g. mitral prolapse w/regurg, aortic stenosis, rheumatic heart dz)

Symptoms

  • F
  • C
  • Sweats
  • Systemic embolic (e.g. stroke) events w/seeding and assoc sx w/mitral or aortic (left sided)
  • Sob w/septic emboli to lung w/infxn w/tricuspid or pulmonic (right sided)
  • LBP w/epidural abscess/vertebral osteo
  • Joint pain and swelling w/septic arthritis
  • Rapidity of clinical progression affected by organism and pt substrate (e.g. Strep Viridans--> can cause sx for weeks; Staph Aureus--> rapid progression to sepsis/death - hours to days)

Physical Exam Findings

  • Fever, other abnl VS (based on degree of illness)
  • New or worse murmur
  • Relatively rare skin findings include Janeway lesions→flat, painless, erythematous lesions on hands
  • Osler's nodes→ painful nodules on fingers
  • Findings associated w/seeding→ e.g. lbp or neuro findings from vertebral osteo, epidural abscess
  • Focal neuro deficits from stroke or brain abscess
  • Joint pain, redness, swelling w/septic arthritis
  • Visual impairment w/retinal involvement (Roth Spots: hemorrhage w/pale center)
  • Conjunctival petechiae

Links