AORTIC VALVE INFECTIVE ENDOCARDITIS

AORTIC VALVE INFECTIVE ENDOCARDITIS. PRESENTED BY : Manjusha.B FROM : Saveetha College of Allied Health Sciences. Chennai, Tamilnadu.

Beginning of knowledge on Endocarditis. Knowledge about the origins of endocarditis stems from the work of Fernel in the early 1500s, and yet thus infection still presents physicians with the major diagnostic and management dilemmas ..

Definition. Infective Endocarditis (IE): an infection of the heart’s endocardial surface , particularly heart valves, is associated with a high degree of illness and death. It occurs in patients with altered and abnormal heart architecture in combination with exposure to bacteria through trauma and other high-risk activities involving transient bacteraemia . Main Classification: Native valve IE Prosthetic valve IE Additional Consideration Intravenous drug abuse (IVDA) IE Nosocomial IE.

Infection causing Organisms. Common bacteria Alpha haem streptococci ( viridans -S. mitis , S. sanguis ) Enterococci Coagulase negative staphylococci Less common bacteria S. aureus B. Haemolytic streptococci Streptococcus pneumonia Not so common Fungi Pseudomonas HACEK group organism.

Infected vs Normal Valve.

Distinction between Acute and Subacute Bacterial Endocarditis Feature Underlying Heart Disease Organism Therapy Acute Heart may be normal S. aureus, Pneumococcus S. pyogenes, Enterococcus Prompt, vigorous and initiated on empirical ground Subacute RHD,CHD, etc. viridans Streptococci, Entercoccus Can often be delayed until culture reports and susceptibilities available.

Symptoms. Acute Sub acute High grade fever with chills Low grade fever SOB Anorexia Myalgias Weight loss Abdominal pain Fatigue Pleuritic chest pain Myalgias Back pain Abdominal pain N/V.

DIAGNOSIS TESTS. 1.Blood culture tests: remains a cornerstone of the diagnosis of Infective endocarditis. 2. Complete blood count 3. Echocardiogram 4. Electrocardiogram 5. Chest X ray TREATMENT 1. Antibiotics (2 to 6 weeks) ( pencillin or ampicillin with gentamicin) 2. Surgery (if antibiotics treatment doesn’t work) (valve repair or valve replacement).

Reporting a cases of Aortic Valve Infective Endocarditis.

He underwent - Blood tests: He underwent two blood cultures drawn for every 12hrs apart which suspected IE by considering duke’s criteria. Positive blood cultures for IE and typical microorganism consistent with IE. Electrocardiogram: showed tachycardia with 112 bpm,wide QRS complex and ST elevation. Echocardiogram: revealed large vegetations attached to right coronary cusp aortic valve, dilated LA and LV, mild AS and severe AR , no clot..

Antimicrobial treatment : he was on antimicrobial treatment for 4 weeks. After again patient underwent blood cultures showed no growth of IE and microorganism. Pencillin IV (2.4g every 4 hrs ) for 4 weeks. Gentamicin (1mg/kg every 12 hrs ) for 2 weeks. Patient condition : Blood cultures are showing decreased microbial growth after antibiotics. Patient is stable and comfortable. But to fix or replace damaged heart valve and clean up any remaining signs of infection he need to undergo surgical treatment. Patient is awaiting for surgical opinion. Surgical treatment: Aortic valve repair Aortic valve replacement.