1. Infective Endocarditis Dr. Raid Jastania

3. Infective Endocarditis Inflammation of the endocardium Common on heart valves Caused by infections: mostly bacteria Resulting in vegetations: thrombotic bebris and organism at the surface of the valve Acute: high virulence organism, severe, acute, on normal healthy valves Subacute: low virulence organism, mild, on diseased defective valves

4. Infective Endocarditis Route of infection –Bacteremia IV drug abusers Other source of infection: skin.. Dental/surgical/catheterization

5. Infective Endocarditis Factors increasing the risk of endocarditis: 1.Pre-existing cardiac abnormlity Valve disease: rheumatic valve disease, calcific aortic stenosis, mitral valve prolapse. Hemodynamic trauma: small VSD 2.Prosthetic valve: 10-20% of cases 3.IV drug abusers: right side of heart

6. Infective Endocarditis Organisms: –Strep viridans: damaged valves 50-60% –Staph aureus: healthy and diseased valve 10- 20% –Others: Hemophilus, Actinobacillus… –Prosthetic valve: Staph epidermidis, Gram negative, fungi –IV drug abusers: Staph aureus, Gram -ve

7. Infective Endocarditis Morphology: –Valve vegetations: Bacteria/fibrin Common on aortic and mitral Single or multiple More than one valve Starts as small lesion and enlarges Bulky friable lesion

9. Infective Endocarditis Morphology: –Valve vegetations –Destruction of valves: Rupture of leaflets, cordae, or papillary muscle Regurgitation CHF –Extend to myocardium: Ring abscess, inflammation, necrosis

10. Infective Endocarditis Morphology: –Valve vegetations –Destruction of valves: –Extend to myocardium: –Emboli: Brain, kidneys…. Abscess in brain kidneys….

11. Infective Endocarditis Morphology: –Valve vegetations –Destruction of valves: –Extend to myocardium: –Emboli –Subacute: less destruction, presence of granulation tissue and chronic inflammation

12. Infective Endocarditis Clinical: –Fever: Low-grade in subacute High-grade with chills in acute –Malaise, weight loss –Change in heart murmur –Clubbing of fingers –Emboli

13. Infective Endocarditis Complications: –Valve regurgitation –CHF –Myocardial abscess –Emboli –Systemic abscess –Mycotic aneurysm –Renal disease

14. Nonbacterial Thrombotic Endocarditis

15. Deposition of small masses of fibrin and platelets On heart valves, common mitral No organisms No valve destruction or inflammation

16. Nonbacterial Thrombotic Endocarditis Pathogenesis –Endothelial injury –Hypercoagulable state Malignancy in 50% of cases

17. Nonbacterial Thrombotic Endocarditis Morphology: –Vegetation: multiple small nodules Along valve closure –Normal healthy valves: aortic, mitral –Fibrin and platelets –No inflammation –May emboli

19. Libman-Sacks Endocarditis

20. Prosthetic Valves

21. Bioprosthetic Mechanical Complications: –Both type: thrombosis, infective endocarditis –Bioprosthetic: calcification, stenosis, tear, regurgitation –Mechanical: hemolysis

23. Pericardial Disease

24. Pericarditis Causes:

25. Pericarditis Causes: –Infections: mostly viruses, bacteria, fungi –Ischemic: following MI –Physical: Following surgery, radiation –Chemical: uremia –Immune: SLE –Malignancy: bloody effusion

26. Pericarditis Fate:

27. Pericarditis Fate: –Acute disease: immediate hemodynamic complications –Resolution –Chronic fibrosing pericarditis (constrictive pericarditis)

28. Pericarditis Clinical –Chest pain –Pericardial rub –Cardiac tamponade: weak heat sound, hypotension/shock, distended neck veins

29. Pericardial Effusion Accumulation of fluid in the pericardial space Transudate VS. Exudate Serous, serosanguineous, chylous, bloody Hemopericardium: in rupture aortic aneurysm, rupture MI, traumatic injury