	Like Discitis, an insidious form of infection
Etiology	- Staph aureus (historically this was S viridans - no longer in the UK!) - coagulase-negative Staph - S bovis (associated with colorectal Ca) 50% of cases are in people with normal valves. Culture negative - Coxiella burnetii - Bartonella - Brucella - HACEK: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)
Epidemiology	Risk factors: cardiac lesions and predisposition to infection Cardiac lesions - prosthetic valve, rheumatic heart disease, congenital heart disease Infection - IVDU, haemodialysis, long lines, high risk surgery, immunosuppressed
Clinical presentation	- malaise, night sweats, anaemia, weight loss - evolving murmur - cardiogenic shock and sepsis - haematuria (glomerulonephritis) - staph aureus bacteraemia - embolic complications - stroke (if PFO), septic pulmonary emboli, mycotic aneursym
Pathogenesis	Damage to endocardium surface → platelet-fibrin clot deposition = sterile clot Transient bacteraemia flows over damaged valve → deposition Vegetations form when bacteria multiply → embolise → immune complex formation
Investigations	ECG: prolonged PR interval, p mitrale, TWI Blood cultures (90% of the time positive) - 3 sets, at least 1h apart - repeat blood cultures 48-72h after starting abx Echo: TTE = 60% sensitive, TOE = 90-99% sensitive, specificity of 90% See Duke criteria
Management:	So passmed says amox and gent... MRCEM success says native valve - amox or vanc+gent prosthetic valve - vanc+gent+rifampicin staph - fluclox strep - benpen HACEK - amox+gent Example guidelines: - native valve = fluclox, gent, unless MRSA colonised → vancomycin - prosthetic valve = as above, add rifampicin

#pathology #cardio

links

https://emcrit.org/ibcc/endo/
https://litfl.com/infective-endocarditis/
https://www.mdcalc.com/calc/1731/duke-criteria-infective-endocarditis or https://ebmcalc.com/BMJ_English_Prod/Endocarditis.htm?q=Endocarditis%20Diagnostic%20Criteria%20--%20Duke%20Criteria&c=suggested
https://radiopaedia.org/cases/endocarditis