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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Knowledge and due consideration of the natural history of valvular heart disease are prerequisites for their operative therapy. Presumptive mortality and morbidity of the surgical intervention must be weighted against the expected prognosis under medical treatment alone. The timing of the operation depends on these considerations. Mitral stenosis and the chronic forms of mitral and aortic incompetence have similar natural histories and for both signs and symptoms are good indicators for an eventual progression of the condition. The length of the period during which the patient is free of complaints may be quite variable but a critical change in the natural history comes about once the disease causes signs and symptoms. Surgical repair is indicated when the patient reaches stage III according to the NYHA-classification. The prognosis is worst for aortic stenosis, in particular due to the danger of sudden death. Patients with high pressure gradients are at particularly high risk; this holds even true for those patients which are not yet suffering from any complaints. The prognosis becomes even more serious, when signs such as dyspnea, anginal pain, or syncopal attacks occur. Prognosis and indication for surgical intervention cannot be evaluated reliably by considering only the clinical signs without knowledge of hemodynamic parameters. Acute mitral and aortic incompetence, in paricular when they occur during baterial endocarditis, must be observed very closely because of their most serious prognosis; if necessary, emergency surgery must be carried out in these cases.
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PMID:[Natural history in patients with mitral- and aorticvalve-disease (author's transl)]. 32 60

Sixteen cases of chronic Q fever are described. In eight there was a history of exposure to infection from farms or farm products. All had valvular heart disease, involving the mitral valve in nine and the aortic valve in seven. Infection occurred on a prosthetic valve in two patients. Arterial embolism was common. Venous thrombosis occured in three patients, and pulmonary embolism occurred in three other patients. Complement fixing antibodies to phase 1 antigen were found in a titre of 1:200 or greater in all except two patients. In one of these post-mortem examination revealed rickettsial bodies in mitral valve vegetations, and in the other Coxiella burneti was isolated from heart valve tissue. The majority presented with infective endocarditis but two presented primarily with liver disease. All patients had evidence of liver involvement and in one this led to death from cirrhosis. Abnormal tests of liver function, particularly hyperglobulinaemia, raised alkaline phsophatase and abnormal bromsulphthalein retention were found in all patients. Hepatic histology was abnormal in all eight patients in whom it was studied. The commonest features were mononuclear cell infiltration of the portal tracts and prominence of the sinusoidal Kupffer cells. Patchy focal necrosis of parenchymal cells, granulomata, fatty change, and eosinophilia of the sinusoidal walls were also noted in several patients and cirrhosis developed in one. Six patients had a purpuric rash, and in 12 there was thrombocytopenia. It is suggested that the presence of hepatomegaly and liver involvement and thrombocytopenia may help to differentiate Q fever endocarditis from bacterial endocarditis. Raised serum IgM and IgA levels occured frequently, but with only a moderate dominance of IgM. Sheep cell agglutination and latex fixation tests for rheumatoid factor were occasionally positive. Several features of the disease suggest the possibility that immune-complex mechanisms may play a role in chronic Q fever. Treatment was with prolonged courses of tetracycline usually combined with lincomycin. Seven patients underwent valve replacement surgery for haemodynamic reasons. Five patients died; two from heart failure, one from cirrhosis, one seven days after valve replacement and one from intraperitoneal haemorrhage following percutaneous liver biopsy. Three patients have survived for more than five years, and another six for more than three and a half years after diagnosis. Of these nine patients, three received medical therapy alone and six required valve replacement as well. Antibiotics have been discontinued in four patients who have had valve surgery and three others. Six patients had received antibiotics for continuous periods varying from 29-62 months. In the period after stopping therapy varying from 15-21 months, no relapse has occured. A seventh patient, who had received antibiotics for four months prior to valve replacement, has survived 43 months after the withdrawal of antibiotics...
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PMID:Chronic Q fever. 94 Sep 18

Tricuspid regurgitation developed in two patients after inferior wall myocardial infarction. Neither patient had preexisting valvular heart disease or evidence of endocarditis, and neither had suffered chest trauma. Because abnormalities in right ventricular function may occur after inferior infarction, and because other known causes of tricuspid incompetence were not present, we postulate that these patients developed valvular regurgitation from dysfunction of the papillary muscle complex controlling tricuspid valve function, a mechanism similar to that proposed to explain mitral regurgitation seen with inferior wall ischemia.
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PMID:Tricuspid regurgitation following inferior myocardial infarction. 124 43

Over 24 months (January 1972-December 1973) 48 intravenous heroin users were admitted to Detroit General Hospital with 50 episodes of bacterial endocarditis (B.E.). Staphylococcus aureus (25 cases), enterococci (13 cases), and Pseudomonas aeruginosa (5 cases) were the usual pathogens, accounting for 86 per cent of these illnesses. Occasional episodes were due to other streptococci or diphtheroids which were susceptible to penicillin G. Staphylococcal and pseudomonas endocarditis usually involved the tricuspid valve, while enterococci affected aortic or mitral valves. Pre-existing valvular heart disease was not the sole determinant of the site of infection.
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PMID:Characteristics of bacterial endocarditis in heroin addicts in Detroit. 126 90

Twenty-seven episodes of bacteremia caused by Staphylococcus warneri were identified at Long Island Jewish Medical Center in New York between 1984 and 1989. Fourteen of these were thought to represent true bacteremias and 13 to represent contaminants. Of the 14 true bacteremias, 5 were in pediatric and 9 were in adult patients. Eight of 14 patients (57%) had catheter-related bacteremia and 5 of 14 had bacteremia of unknown source. There was one case of fulminant native valve S. warneri endocarditis. All cases of catheter-related bacteremia, except one, were nosocomially acquired, and 75% of these patients had an underlying immunosuppressive condition. Only 40% of patients with bacteremias of unknown source were immunocompromised, and S. warneri appeared to be noninvasive in this group. Interestingly, all five of the pediatric isolates were oxacillin susceptible, although four of five were resistant to penicillin, despite the fact these patients were hospitalized an average of 29 days. In contrast, seven of nine adult isolates were resistant to both oxacillin and penicillin. The only case of native valve S. warneri endocarditis occurred in a patient who had no known underlying valvular heart disease, but had an underlying immunosuppressive condition. Identification to species level of coagulase-negative staphylococci may lead to appreciation of the importance of bacteria such as S. warneri as human pathogens.
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PMID:Clinical significance of Staphylococcus warneri bacteremia. 150 May 40

Abnormal embryologic development and inflammatory or degenerative diseases cause valvular heart disease in children. Physicians consider children's age, size, pathology and natural history of the disease, size and anatomy of cardiac chambers and great vessels, and success of past interventions when deciding on valve replacement. The 1st treatment tends to be preservation and reconstruction of the natural valve. It is difficult to obtain a prosthetic valve of adequate size. Because the child is growing quickly the prosthetic valve, quickly becomes too small an hemodynamically restrictive. A prosthetic valve increases the risk of infection. The 3 main types of prosthetic valves are bioprosthetic, mechanical, and allograft valves. Management issues of a child undergoing heart valve replacement surgery include thromboembolism, minimalizing blood coagulation without undue bleeding, endocarditis, and pregnancy. More and more females with prosthetic heart valves are achieving reproductive years. Women with adequately efficient valves and are in the American Heart Association class I or II face a much better likelihood of a successful pregnancy and fetal outcome than those in class III or IV. Indeed women of class III or IV regardless of the conditions of the valve should not become pregnant until their status has been upgraded. Pregnancy risks include ability of the heart to maintain cardiac output and stroke volume and teratogenic effects of sodium warfarin on the fetus. Pregnant patients can receive subcutaneous heparin therapy, however. Nurses can play a leading role in counseling parents of heart valve replacement children. For example, they can educate them and their affected children about contraception while they are in their early teens. Specifically they need to counsel them about the risks of pregnancy and of using estrogen-based contraceptives and IUDs. Diaphragms and condoms along with a spermicide are the best methods for heart valve replacement females.
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PMID:An overview of artificial heart valve replacement in infants and children. 155 84

Bacillus cereus is a ubiquitous organism that infrequently causes serious infections. We report a patient with B. cereus endocarditis involving a mechanical aortic valve. Data for 10 cases of B. cereus endocarditis reported in the literature are summarized. B. cereus is resistant to many commonly used antibiotics, a finding that has clinical significance for empirical antibiotic selection in patients with suspected endocarditis. Infection in patients with valvular heart disease in the few cases reported is associated with significant mortality and morbidity.
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PMID:Bacillus cereus endocarditis: report of a case and review. 157 91

When used appropriately, antimicrobial prophylaxis is highly beneficial and cost effective. Antibiotics are not indicated for "clean procedures" such as hernia and breast surgery. A single preoperative dose will suffice, followed by an intraoperative dose if the operation takes more than 3 hours. For vascular (prosthesis or groin wound), head and neck (pharynx entered), thoracic (gastrointestinal or respiratory entrance) and high-risk gastroduodenal and biliary procedures, cefazolin, 1 g intravenously, is indicated. For procedures involving small intestine, appendix or penetrating abdominal trauma, cefoxitin or cefotetan, 2 g intravenously, is indicated. For colorectal procedures, either oral neomycin plus erythromycin or intravenous aminoglycoside plus clindamycin (or metronidazole) are effective. If valvular heart disease is present, endocarditis prophylaxis should be administered.
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PMID:Antimicrobial prophylaxis in general surgery. 174 29

Thrombus formation in the left atrium and left ventricle is primarily due to stasis of blood which causes activation of the coagulation system. Migration of thrombotic material into the circulation depends on the dynamic forces of the circulation. Atrial fibrillation is the commonest underlying cardiac disorder predisposing to thromboembolism. Rheumatic mitral stenosis, left atrial enlargement, prior myocardial infarction, hypertension, and echocardiographic left ventricular hypertrophy are risk factors for thromboembolic stroke in elderly patients with chronic atrial fibrillation. Non-valvular atrial fibrillation accounts for 45% of cardiac sources of thromboembolic stroke and includes patients with ischemic heart disease, hypertension, thyrotoxic heart disease, hypertrophic cardiomyopathy, chronic sinoatrial disorder, and idiopathic atrial fibrillation. 15% of cardiac sources of thromboembolic stroke are associated with acute myocardial infarction, 10% with left ventricular aneurysm and mural thrombi remote from an acute myocardial infarction, 10% with rheumatic valvular heart disease, and 10% with prosthetic cardiac valves. Mitral valve prolapse, mitral annular calcium, nonischemic cardiomyopathies, infective endocarditis, nonbacterial thrombotic endocarditis, left atrial myxoma, paradoxical embolism associated with congenital heart disease, calcific aortic stenosis, and complex atherosclerotic plaque within the proximal aorta also contribute to thromboembolism.
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PMID:Etiology and pathogenesis of thromboembolism. 176 43

33 patients with infective endocarditis were treated from 1980 to 1989. 31 of them were operated on for primary endocarditis complicated by congenital heart disease (5 patients) and valvular heart disease (26 patients). Two patients (6.5%) died postoperatively and 2 patients with primary endocarditis complicated by aortic insufficiency died without operation. In 10 patients with endocarditis secondary to open-heart surgery, 6 were reoperated upon but 5 of them died; in the remaining 4 who were not reoperated on died. We consider that surgical intervention for endocarditis, either primary or postoperative, should be taken as early as possible after a short period of ineffectiveness of antibiotic therapy.
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PMID:[Surgical intervention of infective endocarditis]. 181 19


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