Septic Pulmonary Emboli (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 R sided valvular heart dz (in particular, tricuspid)

Symptoms

  • F
  • C
  • Sweats
  • Chest pain
  • Lightheadedness, dizzy, confused (sepsis)
  • Systemic embolic events w/seeding and assoc sx
  • Sob w/septic emboli to lung w/infection of right sided (tricuspid) valves
  • Rapidity of clinical progression affected by organism and pt substrate

Physical Exam Findings

  • Fever
  • New or worse murmur of TR
  • 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
  • Lung findings of infiltrate
  • Pleural effusion
  • Chf (edema, elevated jvp); R sided findings may predominate

Tests

Links