eMedicine Specialties > Emergency Medicine > Infectious Diseases

Endocarditis: Follow-up

Author: Keith A Marill, MD, Faculty, Department of Emergency Medicine, Massachusetts General Hospital
Contributor Information and Disclosures

Updated: Feb 5, 2008

Follow-up

Deterrence/Prevention

  • Consider prophylaxis against infective endocarditis in patients at higher risk. Patients at higher risk include those with the following condition:
    • Presence of prosthetic heart valve
    • History of endocarditis
    • Cardiac transplant recipients who develop cardiac valvulopathy
    • Congenital heart disease with a high-pressure gradient lesion
  • The presence of coronary artery stenting is not considered to place the patient at high risk for endocarditis
  • Consider prophylaxis in patients before they undergo procedures that may cause transient bacteremia, such as the following:
    • Any procedure involving manipulation of gingival tissue or the periapical region of teeth, or perforation of the oral mucosa
    • Any procedure involving incision in the respiratory mucosa
    • Procedures on infected skin or musculoskeletal tissue including incision and drainage of an abscess
    • Prophylaxis is no longer routinely recommended for gastrointestinal or genitourinary procedures.
  • For more information, see Medscape's article " Prevention of Infective Endocarditis -- Updated Guidelines ".

Complications

  • Myocardial infarction, pericarditis, cardiac arrhythmia
  • Cardiac valvular insufficiency
  • Congestive heart failure
  • Sinus of Valsalva aneurysm
  • Aortic root or myocardial abscesses
  • Arterial emboli, infarcts, mycotic aneurysms
  • Arthritis, myositis
  • Glomerulonephritis, acute renal failure
  • Stroke syndromes
  • Mesenteric or splenic abscess or infarct

Prognosis

  • Acute endocarditis due to S aureus is associated with a high mortality rate (40%), except when it is associated with IV drug use.
  • Endocarditis due to streptococci has a mortality rate of approximately 10%.
  • Prognosis largely depends on whether or not complications develop.

Patient Education

  • Drug rehabilitation for patients who use IV drugs is critical.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis, especially in patients with a history of IV drug use and a low-grade fever
 


More on Endocarditis

Overview: Endocarditis
Differential Diagnoses & Workup: Endocarditis
Treatment & Medication: Endocarditis
Follow-up: Endocarditis
Multimedia: Endocarditis
References
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References

  1. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. Jun 14 2005;111(23):e394-434. [Medline].

  2. Baddour LM, Wilson WR, Bayer AS. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications - executive summary. Circulation. 2005;111:3167-3184.

  3. Baddour LM, Wilson WR. Infections of prosthetic valves and other cardiovascular devices. In: Principles and Practice of Infectious Diseases. 6th ed. Elsevier Churchill Livingstone; 2005:1022-1044.

  4. Bayer AS, Bolger AF, Taubert KA. Diagnosis and management of infective endocarditis and its complications. Circulation. Dec 22-29 1998;98(25):2936-48. [Medline].

  5. Carroll KC, Cheeseman SH. Infective endocarditis and infections of intracardiac prosthetic devices. In: Irwin and Rippe's Intensive Care Medicine. Lippincott Williams & Wilkins; 2003:1000-15.

  6. Croft LB, Donnino R, Shapiro R, et al. Age-related prevalence of cardiac valvular abnormalities warranting infectious endocarditis prophylaxis. Am J Cardiol. Aug 1 2004;94(3):386-9. [Medline].

  7. Dunmire SM. Infective endocarditis and acquired valvular heart disease. In: Emergency Medicine Concepts and Clinical Practice. Vol 2. Mosby-Year Book; 1998:1745-54.

  8. Durack DT. Prevention of infective endocarditis. N Engl J Med. Jan 5 1995;332(1):38-44. [Medline].

  9. Fowler Jr. VG, Scheld WM, Bayer AS. Endocarditis and intravascular infections. In: Principles and Practice of Infectious Diseases. 6th ed. Elsevier Churchill Livingstone; 2005:975-1022.

  10. Gilbert DN, Moellering RC, Sande MA. The Sanford Guide to Antimicrobial Therapy. 2002:18-21.

  11. Heiro M, Nikoskelainen J, Engblom E. Neurologic manifestations of infective endocarditis: a 17-year experience in a teaching hospital in Finland. Arch Intern Med. Oct 9 2000;160(18):2781-7. [Medline].

  12. Karchmer AW. Infective endocarditis. In: Harrison's Principles of Internal Medicine. 16th ed. McGraw-Hill; 2005:731-40.

  13. Karchmer AW. Infective endocarditis. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed. WB Saunders Co; 2005:1633-1658.

  14. Miro JM, del Rio A, Mestres CA. Infective endocarditis in intravenous drug abusers and HIV-1 infected patients. Infect Dis Clin North Am. Jun 2002;16(2):273-95, vii-viii. [Medline].

  15. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. Nov 1 2001;345(18):1318-30. [Medline].

  16. Shively BK. Infective Endocarditis. Curr Treat Options Cardiovasc Med. Feb 2001;3(1):25-35. [Medline].

  17. Stryjewski ME, Chu VH, Cabell CH. Issues in the Management of Endocarditis Caused by Resistant Gram-positive Organisms. Curr Infect Dis Rep. Aug 2004;6(4):283-291. [Medline].

  18. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation. Oct 2007;116(15):1736-54. [Medline].

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Further Reading

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Contributor Information and Disclosures

Author

Keith A Marill, MD, Faculty, Department of Emergency Medicine, Massachusetts General Hospital
Keith A Marill, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Steven A Conrad, MD, PhD, Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center
Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Program Director, Department of Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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