2017-04-05

1

Infective Endocarditis

NielsEskeBruunDept.Cardiology

Herlev-GentofteHospitalCopenhagenDenmark

Incidence Rate of First Episode of Endocarditis in Denmark

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Erichsen et al. Eur J Intern Med 2016

EchocardiographyinEndocarditis

• Echocardiography plays akey role intheassesment ofpatientswithorsuspected ofhaving infective endocarditis

• http://nbv.cardio.dk/endocarditis

EchocardiographyinEndocarditis

• Diagnosis• Assesment ofseverity• Prediction ofshort-termandlong-termprognosis• Prediction ofembolic risk• Managementofcomplications• Assesment during surgery• Follow-up• Screeninginbacteremia

2017-04-05

2

ENDOKARDITDiagnose

• Klinik• Bloddyrkningerm.m.• Ekkokardiografi

–CT,MR,scintigrafi,PET-CT–Molekylærbiologisketeknikker

Sekundærekliniskefundvedendocarditis

Symptom Percentage

Fever 88-100 %

Sweats and/or chills

13-58 %

Malaise and/or aches

20-45 %

Anorexia or weight loss

13-70 %

Finding Percentage

Cardiac murmur 80-100 %

Petechiae and/or splinters

14-32 %

Splenomegaly 11-68 %

Anemia 63-81 %

Leukocytosis 40-47 %

Clinical Picture in Endocarditis

Dahl and Bruun Expert Rev Cardiovasc Ther 2013

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2017-04-05

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Endocarditis andSLE– Libman-Sacksendocarditis

• Mitral valve replacement• Microbiological examinations:tissue cultures,microscopy,16sPCR:allnegative.

• Histology:Libman-Sacks

Endocarditis andSLE– Libman-Sacksendocarditis

• Mitral valve replacement• Microbiological examinations:tissue cultures,microscopy,16sPCR:allnegative.

• Histology:Libman-Sacks

All imaging resultsmust be evaluatedon the backgroundof clinical, microbiological and clinical laboratorydata !!

Thechangingpatternofendocarditis

• Fewerrheumaticvalvulardiseases• Morenormal,degenerativevalvesandprolaps

• Moreptt´swithintravenouscatheters,HIVandiv.Abusers

• IncreasingageofIEpatients• Changingpatternofmicrobiologicalagents– MoreStaphylocoocusAureus– Moreresistantbacteria– Morenosocomialinfections

• Moreinfectionofdevices

2017-04-05

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Murdoch, Arch Intern Med 2009

ICE databasen

Øst-Danske endokardit database

Dahl A. et al. Phd 2016

Enterococcus faecalis

Danish PM register

2017-04-05

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PatientnoII

• 52yearsoldmanwithBrugada´s syndrom• FirstICDin1996• SeveralchangesofICDlead• VTablationx3• Morethan100relevantshockfromtheICDunit

• Admittedwith12/12BCwithCONS,fever,tired

PatientnoII

• TTE– negative• TEE– negative• PET-CT

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2017-04-05

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Indications forEchogardigraphy insuspected IE

ESC GUIDELINES 2015

TTETOE

Native/ProstheticNative/Prosthetic

Sensitivity 70/50%96/92%

Specificity 90/85%92/90%

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