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Right Heart Endocarditis


Presentation

  • Snapshot A 50-year-old man presents to the emergency room for a fever that has persisted for several days. He denies any history of intravenous drug use or any congenital heart disease.[medbullets.com]
  • In less than 4 per cent of cases, 1 usually when the disease occurs in childhood, vegetations may be present only within the right chambers of the heart on such sites as the tricuspid valve, pulmonary valve, interventricular septal defect or patent ductus[annals.org]
  • Table 1: Demographic, clinical, biological, and echocardiographic characteristics upon admission and evolution data of chronic hemodialysis patients presenting an infective endocarditis ( n 11).[sjkdt.org]
  • Nine (81.8%) and 10 (90.1%) of the 11 patients presented with fever and a new cardiac murmur; however, vascular and immunological phenomena were seen only in 4 (36.4%) and 1 (9.1%) patients, respectively.[jgid.org]
  • (Cardiol J 2010; 17, 2: 205-210) Abstract This paper presents a literature review on right heart endocarditis in patients with a permanent pacemaker (PM) or implantable cardioverter-defibrillator (ICD).[journals.viamedica.pl]
Fever
  • While fever and heart murmur predominate in IE of the left heart, fever and lung impairment are the main signs of IE of the right heart. These nonspecific signs explain the great delay in diagnosis.[sjkdt.org]
  • […] of unknown origin endocarditis prophylaxis may be required before dental procedures Presentation Symptoms persistent fevers (the most common symptom) shortness of breath systemic symptoms weakness fever malaise Physical exam new murmur on auscultation[medbullets.com]
  • For example, fever, malaise, weakness, and shortness of breath are common symptoms of endocarditis.[medicinenet.com]
  • Once the fever and the worst of the symptoms have gone away, the patient may be able to continue antibiotic therapy at home.[medical-dictionary.thefreedictionary.com]
  • If, despite these measures, the fever remains, the possibility of antibiotic resistance should be considered and a further synergistic antimicrobial treatment may be required. A second site for fever should always be excluded.[ncbi.nlm.nih.gov]
Chills
  • A 23-year-old woman comes to the hospital due to fever, chills, dyspnea, and cough for the past several days. She also has a sharp right-sided chest pain exacerbated by breathing.[quizlet.com]
  • Other symptoms that can occur with endocarditis are chills, night sweats, fatigue, joint and muscle aches, and swelling of the legs, abdomen, and feet due to fluid accumulation (edema).[medicinenet.com]
  • Acute Infective Endocarditis can be marked by a high fever, shake chills, extreme fatigue as well as chest pain, shortness of breath which can come suddenly.[verywell.com]
  • Find out more about the causes of endocarditis Symptoms of endocarditis The initial symptoms of endocarditis are similar to flu and include: a high temperature chills headache joint and muscle pain Without treatment, the infection damages the heart valves[nhs.uk]
  • The symptoms of acute IE usually begin with fever (102 –104 F), chills, fast heart rate, fatigue, night sweats, aching joints and muscles, persistent cough or swelling in the feet, legs or abdomen.[heart.org]
Rigor
  • […] based on course of untreated disease: acute, subacute, chronic Newer classification system is based on causative organism Also classify based on native valve or prosthetic valve endocarditis Clinical features Vague constitutional symptoms such as fever, rigors[pathologyoutlines.com]
  • A 33-year-old male, intravenous drug abuser presented with history of fever, rigors, night sweats, cough, pleuritic chest pain, hemoptysis, and worsening dyspnea of two months duration.[heartviews.org]
  • Constitutional symptoms Endocarditis should be considered in patients with vague or generalized constitutional symptoms such as fever, rigors, night sweats, anorexia, weight loss, or arthralgia.[ncbi.nlm.nih.gov]
  • […] phenomena: glomerulonephritis which allows for blood and albumin to enter the urine, [7] Osler's nodes (painful subcutaneous lesions in the distal fingers), Roth's spots on the retina, positive serum rheumatoid factor Other signs may include night sweats, rigors[en.wikipedia.org]
Pallor
  • ., numbness or tingling, changes in pulses, pallor, and coolness in an extremity). Blood cultures may be taken periodically to monitor the effectiveness of antibiotic therapy.[medical-dictionary.thefreedictionary.com]
  • […] stroke with focal neurologic deficits: The most common neurologic sign Intracerebral hemorrhage Multiple microabscesses Other signs of IE include the following: Splenomegaly Stiff neck Delirium Paralysis, hemiparesis, aphasia Conjunctival hemorrhage Pallor[emedicine.medscape.com]
Italian
  • Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian Study on Endocarditis. Infection. 2012;40(5):527–35. PubMed CrossRef Google Scholar 3.[link.springer.com]
Cough
  • A 23-year-old woman comes to the hospital due to fever, chills, dyspnea, and cough for the past several days. She also has a sharp right-sided chest pain exacerbated by breathing.[quizlet.com]
  • The symptoms of acute IE usually begin with fever (102 –104 F), chills, fast heart rate, fatigue, night sweats, aching joints and muscles, persistent cough or swelling in the feet, legs or abdomen.[heart.org]
  • A 40-year-old man who was a smoker with no history of intravenous drug use presented to a tertiary hospital with a week-long high-grade fever, dry cough, and streaky hemoptysis. He had hypoxia at room air.[circ.ahajournals.org]
  • […] over 100 degrees Night sweats Skin rash Pain, tenderness, redness or swelling Wound or cut that won’t heal Red, warm or draining sore Sore or scratchy throat Sinus drainage, nasal congestion, headaches or tenderness along upper cheekbones Persistent cough[health.clevelandclinic.org]
Dry Cough
  • A 40-year-old man who was a smoker with no history of intravenous drug use presented to a tertiary hospital with a week-long high-grade fever, dry cough, and streaky hemoptysis. He had hypoxia at room air.[circ.ahajournals.org]
Tachypnea
  • Heart failure In infants, symptoms or signs of heart failure include Tachycardia Tachypnea Dyspnea with feeding Diaphoresis, especially with feeding Restlessness, irritability Hepatomegaly Dyspnea with feeding causes inadequate intake and poor growth,[msdmanuals.com]
Heart Disease
  • Isner Springer Science & Business Media, ٠٦‏/١٢‏/٢٠١٢ - 342 من الصفحات It is quite natural that literature related to car heart disease, cardiomyopathy, pulmonary and diac structure, function, pathology, and patho pulmonary vascular disease, trauma, acquired[books.google.com]
  • Improving heart disease knowledge and research participation in adults with congenital heart disease (the health, education and access research trial: HEART-ACHD). Int J Cardiol 2013 ; 168 : 3236 – 3240. 19.[cambridge.org]
  • heart disease (including children with palliative shunts and conduits) Completely repaired congenital heart disease during the first 6 mo after surgery if prosthetic material or a device was used Repaired congenital heart disease with residual defects[msdmanuals.com]
  • In children, congenital heart disease is the major predisposing factor (50% 75%), which is followed by rheumatic heart disease (12%) or a structurally normal heart (14% 40%) [ 9 ].[clinmedjournals.org]
Heart Murmur
  • With a stethoscope, a doctor can listen to your chest for the distinct sound of a new heart murmur or a change in the sound of an old heart murmur. Heart murmurs are caused by the sound of faulty heart valves and by certain defects in your heart.[texasheart.org]
  • Have a new heart murmur. Endocarditis can cause a new or additional heart murmur, or unusual sound in your heartbeat, or changes to an existing one. See changes in your skin. Tiny bumps or spots may show up on your hands or feet.[webmd.com]
  • They will also check for fever, nodules, and other signs and symptoms, such as a heart murmur, or an altered heart murmur if the patient already had one. A series of tests may be used to confirm endocarditis.[medicalnewstoday.com]
  • Your doctor will examine you, and will check for fever; skin symptoms of endocarditis (tiny hemorrhages in the skin, tender nodules on finger and toes); and a heart murmur, which indicates possible heart valve damage.[drugs.com]
  • A new heart murmur or a change in an existing heart murmur. Skin changes such as: Overall paleness. Small, painful, red or purplish bumps under the skin on the fingers or toes.[surgery.ucsf.edu]
Tachycardia
  • Digoxin use in the treatment of neonatal supraventricular tachycardia has declined because it results in higher mortality than treatment with propranolol ( 2 ).[msdmanuals.com]
  • Löffler's endocarditis, Löffler's parietal fibroplastic endocarditis endocarditis associated with eosinophilia, marked by fibroplastic thickening of the endocardium, resulting in congestive heart failure, persistent tachycardia, hepatomegaly, splenomegaly[medical-dictionary.thefreedictionary.com]
Changing Cardiac Murmurs
  • If patients with uncorrected or incompletely corrected cardiac anomalies developed mild fever and anemia with malaise, and had a new or changing cardiac murmur, the diagnosis of infective endocarditis should be considered, and blood cultures of bacteria[clinmedjournals.org]
Systolic Murmur
  • Murmurs Most left-to-right shunts and obstructive lesions cause systolic murmurs. Systolic murmurs and thrills are most prominent at the surface closest to their point of origin, making location diagnostically helpful.[msdmanuals.com]

Workup

  • […] consistent with IE Echocardiogram results consistent with IE but not meeting major echocardiographic criteria A definitive clinical diagnosis can be made based on the following: 2 major criteria 1 major criterion and 3 minor criteria 5 minor criteria See Workup[emedicine.medscape.com]
Blood Culture Positive
  • positive for infectious organisms Blood cultures that are positive for microorganisms, which are taken 12 hours apart 3 blood cultures positive on separate occasions that are taken at least 1 hour apart Abnormalities in echocardiogram showing either a[dovemed.com]
  • The Duke Criteria for the Clinical Diagnosis of Infectious Endocarditis Major criteria Positive blood culture Two separate blood cultures positive for microorganism consistent with infectious endocarditis (viridans Streptococcus, Streptococcus bovis,[aafp.org]
  • The criteria combine the clinical, microbiologic, pathologic, and echocardiographic characteristics of a specific case [2] : Major blood culture criteria for IE include the following: Two blood cultures positive for organisms typically found in patients[emedicine.medscape.com]

Treatment

  • Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the task force on the prevention, diagnosis, and treatment of infective endocarditis of the European Society of Cardiology (ESC).[link.springer.com]
  • One patient was under tuberculosis treatment for pulmonary tuberculosis (case no. 11). All patients had native valves.[sjkdt.org]
  • Reasons for Treatment Failure Table 3. Table 3. Reasons for Treatment Failure According to the Adjudication Committee.[nejm.org]
  • Outcomes of combination of both medical and surgical treatment for fungal endocarditis are better than medical treatment alone.[medical-case-reports.imedpub.com]

Prognosis

  • Septicemia in dialysis patients: incidence, risk factors, and prognosis. Kidney Int 1999;55:1081-90. 3. USRDS (U.S.[sjkdt.org]
  • Surgery may be required in some cases Untreated Intravenous Drug Abuse Endocarditis can lead to an extremely poor prognosis and is almost always be fatal. With appropriate early diagnosis and treatment, the outcomes are better.[dovemed.com]
  • In cases in which endocarditis is caused by fungi, the prognosis is usually worse than for bacterial endocarditis.[drugs.com]
  • Prognosis With effective treatment, patients with IE have a 70% survival rate. The prognosis is worse if there is no identifiable organism or if there is a resistant organism.[ncbi.nlm.nih.gov]
  • The prognosis appears to be more favorable than for left-sided endocarditis.[revespcardiol.org]

Etiology

  • We highlight the changes in etiology and risk factors and demonstrate improvement in outcomes and mortality in comparison to prior studies. [2], [3] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest 1.[jgid.org]
  • General reference Etiology Environmental and genetic factors contribute to the development of congenital heart disease.[msdmanuals.com]
  • Etiology IE has a large number of causative organisms. Streptococci These account for 50%–80% of IE cases.[ncbi.nlm.nih.gov]
  • […] valve tricuspid valve tricuspid valve disease is associated with intravenous (IV) drug use Staphylococcus aureus, Pseudomonas, Candida risk factors rheumatic heart disease IV drug use immunosuppression prosthetic heart valve congenital heart disease Etiology[medbullets.com]
  • […] ventricular septal defect (VSD), vegetations can be found on the right ventricular side of the VSD, on the tricuspid valve or where the jet impinges on the right ventricular wall Vegetations found in coarctation usually occur distal to the obstruction Etiology[pathologyoutlines.com]

Epidemiology

  • Epidemiologic features and long-term outcome of dialysis patients with infective endocarditis in Taiwan. Int J Cardiol 2015;179:465-9. 30. Montasser D, Bahadi A, Zajjari Y, et al.[sjkdt.org]
  • Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian Study on Endocarditis. Infection. 2012;40(5):527–35. PubMed CrossRef Google Scholar 3.[link.springer.com]
  • Right-sided infective endocarditis: Recent epidemiologic changes. Int J Clin Exp Med 2014;7:199-218. Correspondence Address : Dr.[jgid.org]
  • The protocol covered 90 variables 11 : 19 epidemiologic, 8 clinical, 10 analytical, 4 radiographic, 6 electrocardiographic, 13 microbiological, 16 echocardiographic, and 14 follow-up characteristics.[revespcardiol.org]
  • Introduction Clinical definition inflammation of the heart valve, typically secondary to infection Epidemiology location mitral valve tricuspid valve tricuspid valve disease is associated with intravenous (IV) drug use Staphylococcus aureus, Pseudomonas[medbullets.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of IE in CHD is complex and not completely understood.[sjkdt.org]
  • […] defibrillator, IVDA (right sided endocarditis), indwelling catheter Congenital heart disease: small ventricular septal defect, bicuspid aortic valve, coarctation of aorta, patent ductus arteriosus Uncommon with large VSD, mitral stenosis, atrial septal defect Pathophysiology[pathologyoutlines.com]
  • Pathoanatomic, pathophysiologic and clinical correlations in endocarditis (first of two parts). N Engl J Med. 1974 Oct 17. 291(16):832-7. [Medline]. Wang CC, Lee CH, Chan CY, Chen HW.[emedicine.medscape.com]
  • Pathophysiology Cyanotic Acyanotic (left-to-right shunts or obstructive lesions) The physiologic consequences of congenital heart anomalies vary greatly, ranging from a heart murmur or discrepancy in pulses in an asymptomatic child to severe cyanosis,[msdmanuals.com]
  • Pathophysiology The development of infectious endocarditis requires the presence of bacteria or fungi in the blood and an intracardiac surface on which these microorganisms can attach.[aafp.org]

Prevention

  • Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the task force on the prevention, diagnosis, and treatment of infective endocarditis of the European Society of Cardiology (ESC).[link.springer.com]
  • The following are points to remember about the timing of surgery among patients with IE: The main indications for early surgery in IE are heart failure, uncontrolled infection, and prevention of embolization.[acc.org]
  • Prevention Prevention, for IV drug users, comes with hygienic injecting practises.[blackpoppymag.wordpress.com]
  • Ongoing preventive antibiotics. To stop endocarditis from recurring, some people take preventive antibiotics throughout life, particularly before dental work or other surgical procedures.[health.clevelandclinic.org]
  • Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation 2007 ; 116 : 1736 – 1754. 8. Ferlie, E, Shortell, S.[cambridge.org]

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