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General Medicine

Endocarditis, Infective

Theodore B. Flaum, DO, FACOFP and Samantha Faryn Gottlieb, DO, MS Reviewed 06/2020
 


BASICS

Infective endocarditis is a noncontagious infection of the heart, including valves (native or prosthetic), the endocardium and septal defects. Infective endocarditis occurs worldwide and is gen...

DIAGNOSIS

  • Modified Duke Criteria (1)[B] (definite: 2 major criteria, or 1 major and 3 minor criteria, or 5 minor criteria; possible: 1 major and 1 minor or 3 minor criteria)

  • Major clinical criteria

    • Posi...

TREATMENT

MEDICATION

First Line

  • Start empiric treatment after three sets of blood cultures have been drawn. Results guide treatment.

    • Native valves: ampicillin-sulbactam 12 g/day IV divided into 4 doses w...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Check gentamicin peak (~3 μg/mL) and trough (<1 μg/mL) levels if used for >5 days and with renal dysfunction. Perform twice-weekly BUN and...

REFERENCES

1
Baddour LM, Wilson WR, Bayer AS, et al; for American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Youn...

CODES

ICD10

  • I33.0 Acute and subacute infective endocarditis

  • I39 Endocarditis and heart valve disord in dis classd elswhr

  • A54.83 Gonococcal heart infection

  • B37.6 Candidal endocarditis

ICD9

  • 421.0 Acute and su...

CLINICAL PEARLS

  • Antibiotic prophylaxis is recommended for patients with artificial heart valves, a previous history of infective endocarditis, congenital heart disease, and cardiac transplants with va...

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FIGURE 11.94. Transesophageal echocardiogram recording a transverse view in a patient with mitral valve endocarditis and a perforation of the anterior leaflet. A: Note the distinct break in the continuity of the anterior leaflet (arrow), with remnants of mitral valve tissue protruding into the left atrium (LA). B: Note the distinct convergence zone directed through the defect in the anterior leaflet (left arrow) and a lesser degree of mitral...
FIGURE 11.94. Transesophageal echocardiogram recording a transverse view in a patient with mitral valve endocarditis and a perforation of t...
Bacterial endocarditis. The mitral valve shows destructive vegetations, which have eroded through the free margins of the valve leaflets.
Bacterial endocarditis. The mitral valve shows destructive vegetations, which have eroded through the free margins of the valve leaflets.
Bacterial endocarditis. The aortic valve of an intravenous drug abuser displays adherent vegetations.
Bacterial endocarditis. The aortic valve of an intravenous drug abuser displays adherent vegetations.
FIGURE 13.1. An example of vegetations involving the mitral and aortic valves is shown. The vegetations are indicated by the arrows. LA, left atrium; LV, left ventricle.
FIGURE 13.1. An example of vegetations involving the mitral and aortic valves is shown. The vegetations are indicated by the arrows. LA, le...
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