Infective Endocarditis

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Welcome to lecture 15 of our course. infective endocarditis. infective endocarditis is a serious disorder in which an infectious organism colonizes and causes inflammation of the heart valves. It can be caused by a wide variety of bacteria and fungi. If it covered up endocarditis usually presents with fever of unknown origin, and in most cases, there's a predisposing cardiac conditions such as a bicuspid aortic valve, rheumatic heart disease, prosthetic valves, or a congenital shunt. This is an ASD, visualized in the sub costal view in case you're wondering.

Some especially variant organisms, however, such as staphylococcus can infect completely normal valves. The mitral and aortic valves are the most commonly affected valves or the although the tricuspid valve is most commonly affected in venous infections such as an IV drug addicts or infected central catheters. The echocardiography features of infective endocarditis can include vegetations Which are actually the masses of infected tissue generally localized on valve leaflets. And they can vary in size from a few millimeters to larger vegetations to huge masses in some cases, which can obstruct valves. Larger vegetations are more common with fungal endocarditis. The second feature of infective endocarditis is an abscess, which is usually a Peri valvular collection of pus more common around the aortic valve, or with prosthetic valves and this is an urgent indication for surgery.

When around a prosthetic valve, it presents a high risk of valve the third feature is perforation. Sometimes vegetations may not be visible on a valve, but one or more perforations of the valve leaflets may be observed. And this is more common with staphylococcus endocarditis. When when valve regurgitation is found in a patient suspected of suspected of infective endocarditis, you should always go out of your way to try and visualize the neck of the regurgitated jet and whether it shoots through the valve commissure or through a perforation in the leaf itself. This is a case of aortic valve perforation, due to infective endocarditis, and you can see the regurgitation jet, and the neck of the jet is nowhere near the valve commissure but at the base of the leaflets. This is another example with perforation of the tricuspid valve.

And let me get a still image of that for you. You can see how the jet shoots through the leaflet away from the closure line that's removed color and you can see the defect and the posterior leaf of the tricuspid valve. These are the characteristic features of infective endocarditis. However, the truth is that in most cases, none of them may be evident in first using transthoracic echo. What would certainly be suspicious however, and would prompt you to refer the patient for transesophageal echo is simply the presence of valve dysfunction in a clinically suspicious setting, especially new valves dysfunction. If the patient has a previously normal Echo, it's important to add that when the clinically suspicious patient has a prosthetic valve transesophageal echo is always indicated even if the valve is normal by transthoracic echo.

This brings us to the end of this lecture. Our next lecture will be about era dissection. see you all there

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