ESC Congress - News - 2007 - ENDOCARDITIS

ESC Congress - 2007

Date : 3 September 2007

Reported by : Boudoulas, Harisios (Greece)

Challenges in endocarditis Symposium

Infective endocarditis is a serious and often fatal disease with multiple cardiac and extracardiac manifestations. As a general rule, endocarditis affects patients with underlying valvular heart disease (especially prosthetic valves) and congenital heart disease. Patients with intracardiac catheters, e.g. pacemakers, defibrillators, are also prone to endocarditis. The disease is common in IV drug abusers and patients with compromised immune systems. Criteria and guidelines have been established for the diagnosis and management of endocarditis; these guidelines however cannot replace clinilca judgement, clinical experience and common sense. Endocarditis should be suspected in any patient with unusual symptoms, fever, “Not feeling well”, especially if a heart murmur is present.

Patients with endocarditis or suspected endocarditis should be managed in a large medical center where a cardiologist, a cardiac surgeon, and an infectious disease physician should be involved in the patient’s care. Blood cultures should be obtained in all patients, and therapy with antibiotics should be based on the isolated microorganism and sensitivity tests. It should be emphasised that up to 30% of blood cultures could be negative if they are obtained after the initiation of antibiotic therapy.

A transoesophageal echocardiogram (TEE) should be performed in all patients with endocarditis. Size and precise location of vegetations, aortic root abscess (10-30% of patients) can be only defined with TEE. Surgery, if it is indicated (heart failure, embolic events, large size vegetations) should be performed without delay.

Extracardiac manifestations of endocarditis, such as skin lesions, neurologic phenomena, renal and other organ involvement are not uncommon. Clinical manifestations of endocarditis in developing countries may be quite different. As a general rule, the diagnosis is delayed (more than a month) and the presence of other infectious diseases, e.g. malaria, may alter the clinical picture and the course of the disease.

Patients with valvular heart disease, congenital heart disease and intracardiac catheters should maintain the best oral hygiene to prevent endocarditis.

Conclusions:

Endocarditis is a serious and often fatal disease with multiple cardiac and extracardiac manifestations. The management of endocarditis should be based primarily on good clinical judgement and common sense. Patients with endocarditis should be managed in a large medical center. A cardiologist, cardiac surgeon and infectious diseases specialist should be involved in the patient’s care. Blood cultures should be obtained in all patients with suspected endocarditis prior to therapy with antibiotics. Optimal oral hygiene can help prevent the development of infective endocarditis