1. Infective edocarditis

2. Definition  an infection of the endocardium or vascular endothelium  it may occur as fulminating or acute infection  more commonly runs as subacute bacterial endocarditis (SBE)

3. SBE occurs  on rheumatic or congenitally abnormal valves  in mitral valve prolapse  in calcified aortic valve Congenital lesions:  ventricular septal defect (VSD)  Persistent ductus arteriosus (PDA) Prosthetic valves

4. The lesion of infective endocarditis is a mass of fibrin, platelets and infecting organisms known as a vegetation.

5. Aetiology  Streptococcus viridans (50%)  Enterococcus faecalis  Staphylococcus aureus (50% of acute cases)  Staphylococcus epidermidis  Coxiella burnetti  Gram-negative

6. Subacute endocarditis  Fever  Night sweats  Weight loss  Weakness  Cardiac failure  Embolism  Heart murmur  Onset of the disease is unknown

7. Acute endocarditis  Intravenous drug abusers  Following an acute suppurative illness  Persistence of fever  Development of heart murmur  Vasculitis  Metastatic abscesses  The onset of the illness: chordal rupture or acute valvular destruction

8. Prosthetic endocarditis  develops soon after surgery  Occurs late and follows a bacteraemia  In both cases the valve ring in infected

9. Clinical features Endocarditis must be suspected in a patients with a heart murmur and a fever

10. Cardiac findings development of a new murmur or a change in the charakter of an existing murmur

11. Vascular lesions  Vasculitis (small petechial or mucosal haemorrhages, they are small, red, usually with a pale center, when seen on the retin – Roth spots, seen on the thenar or hypothenar eminences - Janeway lesions  Embolic lesions (hard, painful, tender, subcutaneous swellings occurs in the fingers, toes, palms and soles (Osler’ nodes)

12. Clinical Features  Clubbing of the fingers  Splenomegaly  Renal lesions (haematuria, proteinuria)  Arthritis  Infarcts 

13. Investigaion  Blood (anaemia, leucocytosis, CRP)  Liver biochemistry in often but mildly disturbed  Immunoglobulins are increased  Total complement and C3 are decreased  Urine:protein and blood (microscopic haematuria)

14. Echocardiography  Is used to visualize vegetations  To document valvular dysfunction  To identify patients in need of urgent surgery

15. Drug therapy  Antibiotics are chosen on the basis of the results of the blood culture  The treatment should continue 4-6 weeks

16. Surgical treatment  Extensive damage to a valve  Early infection of prosthetic material  Worsening renal failure  Persistent infection  Large vegetations  Progressive cardiac failure

17. Congenital heart disease

18. Aetiology  Maternal rubella infection  Maternal alcohol abuse  Maternal drug treatment and radiation  Genetic abnormalities  Chromosomal abnormalities (Turner’s and Down’s syndrome)

19. Symptoms  Central cyanosis  Pulmonary hypertension  Clubbing of the fingers  Paradoxical embolism  Reduced growth  syncope

20. Treatment  A significant ASD (pulmonary flow that in more than 50 % is increased when compare with systemic flow) 

21. Ventrical septal defect  Left ventricular pressure (LVP) is higher than RVP  blood moves from LV to RV and pulmonary blood flow   obliterative pulmonary vascular changes may cause the pulmonary arterial pressure to equal the systemic pressure (Eisenmenger’s syndrome)  the shunt is reduced or reversed and central cyanosis may develop

22. Clinical features Small VSD  systolic murmur  Asymptomatic patients  Usually close spontaneously Moderate VSD  Laud systolic murmur  Some fatigue and dyspnoea  Cardiac enlargement and prominent apex beat

23. Treatment  Surgery (moderate and large VSD)  Prophylaxis of endocarditis

24. Atrial Septal defect (ASD)  Type I ostium secundum systolic murmur  Type II ostium primum  Common form of ASD is type I

25. Clinical features Children  Most children are asymptomatic  Pulmonary infection  Dyspnoe and weakness

26. Clinical features  Age > 30:  AF  RVH  RVF  Second sound is wide and fixed  Loud ejection systolic pulmonary flow murmur