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Endocarditis, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

An inflammation of the endothelial surface of the heart 
  • Various cardiac structures may be involved:

    • Native heart valves (most common)

    • Prosthetic valves

    • Interventricular septum

    • Chordae te...

Diagnosis

Signs and Symptoms

  • Fever:

    • Present in 86% of patients

    • May be absent in certain settings:

      • Elderly

      • CHF

      • Severe debility

      • Chronic renal failure

      • Flulike illness

      • Chills

      • Sweats

      • Rigors

      • Malaise

  • Head, eyes, ears, no...

Treatment

Initial Stabilization/Therapy

  • Monitor for signs of heart failure.

  • Operative repair if:

    • Severe valvular dysfunction causing failure

    • Unstable prosthesis

    • Perivalvular extension with intracardiac abs...

Follow-Up

Disposition

Admission Criteria

  • Patients with risk factors who exhibit pathologic criteria or clinical findings

  • All IV drug users with fever

  • Admit patients with cardiovascular instability to an i...

Pearls and Pitfalls

  • Fever, new or changing murmur

  • 50% of cases occur in patients with no known history of valve disease

  • Recent health care exposure/device consider as risk factor

  • Common complications; wa...

Additional Reading

  • Chen  RS, Bivens  MJ, Grossman  SA. Diagnosis and management of valvular heart disease in emergency medicine. Emerg Med Clin North Am.  2011;29(4):801–810.

  • Hoen  B, Duval  X. Cl...

Codes

ICD9

  • 421.0 Acute and subacute bacterial endocarditis

  • 424.90 Endocarditis, valve unspecified, unspecified cause

  • 996.61 Infection and inflammatory reaction due to cardiac device, implant, and graft

  • 42...

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