Infective endocarditis (IE) is an infection of the endocardium | FreeMedSite

Infective endocarditis (IE) is an infection of the endocardium that typically affects one or more heart valves. The condition is usually a result of bacteremia, which is most commonly caused by dental procedures, surgery, distant primary infections, and nonsterile injections.

IE may be acute (developing over hours or days) or subacute (progressive over weeks to months).

Acute bacterial endocarditis is usually caused by Staphylococcus aureus and causes rapid destruction of endocardial tissue, while
subacute bacterial endocarditis is most commonly caused by viridans streptococci and generally affects individuals with preexisting damage to the heart valves, structural heart defects, or prosthetic valves.

Clinical features include constitutional symptoms (fatigue, fever/chills, malaise), signs of pathological cardiac changes (e.g., new or changed heart murmur, heart failure signs), and, in some cases, manifestations of subsequent damage to other organs (e.g., glomerulonephritis, septic embolic stroke).

Management is complex and infectious disease specialists should be involved early. Diagnosis is made based on the Duke criteria, the main features of which are positive blood cultures and evidence of endocardial involvement on echocardiography.

Initial treatment of IE consists of empiric IV antibiotics, which are then adapted to blood culture results and continued for several weeks. Categorization into native valve endocarditis or prosthetic valve endocarditis helps to further tailor regimens.

Surgery may be necessary for complex cases (e.g., valve perforation). Prophylaxis against IE is administered in certain circumstances, e.g., in patients with preexisting heart conditions, such as congenital heart disease, undergoing dental or surgical procedures. IE is typically fatal if left untreated.