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

Echocardiographic evaluation of the mitral valve has attracted much attention and generated much discussion since its beginnings, some thirty years ago. Echocardiography affords the physician a detailed assessment of mitral valve integrity unequalled by any other non-invasive test. Aside from the normal appearance of the valve, a variety of pathological conditions have been studied in detail; mitral stenosis was the first and over the years the state-of-the-art has evolved from simply looking at the EF slope as an indicator of severity to the accurate quantification utilizing planimetry and 'pressure half-time.' Mitral regurgitation, although not as well quantified as mitral stenosis, can be detected and its etiology usually determined. Mitral valve prolapse may easily be overdiagnosed by echocardiography, however together with auscultation, ultrasound remains the best way to evaluate this common condition. Echocardiography is also invaluable in the evaluation of endocarditis and prosthetic mitral valves.
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PMID:Echocardiography in mitral valve disease: a review. 391 35

Although coagulase-negative staphylococci (CoNS) are frequent etiologic agents in prosthetic valve endocarditis, they rarely infect native heart valves. We report three cases of CoNS endocarditis in patients with mitral valve prolapse (MVP). Review of other reports of MVP-associated endocarditis and of the limited experience with CoNS infection of native heart valves suggests that our experience is not unique. Coagulase-negative staphylococcal endocarditis superimposed on MVP may be difficult to recognize and to treat. The cardiac dysfunction can be quite subtle, the clinical course indolent, the blood culture results difficult to interpret, and the response to antimicrobial agents suboptimal.
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PMID:Coagulase-negative staphylococcal endocarditis. Occurrence in patients with mitral valve prolapse. 394 44

The clinical relevance of the echocardiographic finding of mitral valve prolapse (MVP) is largely unclear. Therefore we made a prospective study of 470 patients with MVP established by M-mode echocardiography (63.7% holosystolic, 36.3% late systolic) over an average period of 2.7 years, corresponding to an observation period of 1,269 patient years. Patients with hemodynamically relevant mitral insufficiency were excluded from the study, as were patients with additional cardiac disorders. Three patients died, two of non-cardiac causes, but one probably in sudden cardiac death. 54.8% complained of angina pectoris, 15.6% of dyspnea. 14.4% suffered from non-orthostatic vertigo. 23.3% had one or more syncopes, 14.9% for the first time during the period of observation. 43.4% suffered from rhythm disturbances, 10.2% for the first time during the period of observation. Patients with rhythm disturbances experienced non-orthostatic vertigo (p less than 0.01) and syncopes (p less than 0.01) more frequently than patients without rhythm disturbances. During the study none of the patients developed endocarditis and none had an arterial embolism. Patients with late systolic MVP and a click experienced syncopes more frequently than those with holosystolic MVP without a click (p less than 0.05). Further correlations between the echocardiographic picture, auscultatory findings, age, sex and weight on the one hand and clinical progress on the other hand, were not found. Thus prognosis for MVP with regard to survival seems to be good. Nonetheless, complaints, even potentially threatening syncopes, are frequent. Neither clinical nor echocardiographic findings permit a prognostic statement.
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PMID:[Clinical course of 470 patients with mitral valve prolapse]. 396 12

To determine the causes of ruptured chordae tendineae and a suspected etiologic role for mitral valve prolapse (MVP), the mitral valve in 25 consecutive and surgically proved cases of chordal rupture were examined. The diagnosis of MVP was made on the basis of redundancy and marked hooding of the mitral leaflets and on histologic changes. MVP was the underlying morphologic abnormality in 23 patients, only 1 of whom had infective endocarditis that was responsible for the rupture. Thus MVP was the only underlying morphologic abnormality in 22 of 25 patients (88%). Another finding in this study was the demonstration of auscultatory and angiographic or echocardiographic evidence of MVP in 4 patients, aged 4 to 11 years (mean 7), before chordal rupture; no patient had had endocarditis. The morphologic and historical evidence would indicate that MVP is probably the most common cause of so-called spontaneous chordal rupture.
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PMID:Mitral valve prolapse and ruptured chordae tendineae. 396 73

This article presents the fundamental knowledge nurse practitioners need when managing the care of a client with mitral valve prolapse (MVP). The assessment discussion includes information on where and how to perform cardiac auscultation, and it also includes a discussion of the particular mid-to-late systolic click with murmur that is typical of MVP. Client preparation for diagnostic tests (echocardiogram and ECG) is also presented. Potential complications of endocarditis, mitral regurgitation, ventricular dysrhythmia, chest pain, systemic emboli and sudden death are discussed. Particular emphasis is given to the nursing management and client teaching that are required for clients with MVP. Nursing management includes teaching the client 1) the need and schedule for chemoprophylaxis of endocarditis, 2) how to maintain left ventricular volume, 3) the possible relationship between chest pain and hypovolemia and 4) the advantages of regular exercise. Changes in the click-murmur that may occur with pregnancy and the impact of MVP on contraception and childbearing decisions are discussed. Specific nursing diagnoses that may arise with the client with MVP are listed. Outcome criteria that may be used for evaluation of nursing care are provided.
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PMID:Mitral valve prolapse: physical assessment complications and management. 399 Oct 84

Fifty consecutive patients (36 male, 14 female, mean age 28 years) who had heart murmurs and clinical and radiographic evidence of straight upper dorsal spine (straight back syndrome, SBS) underwent detailed clinical, electrocardiographic, roentgenographic, and echocardiographic evaluation. Palpable systolic thrill noted in one (2%) and widened S2 with persistent splitting in 2 (4%) patients were uncommon. Murmurs were invariably systolic in nature. Those located at the base of the heart in 19 (38%) patients were ejection in type and best heard during expiration. Those located at the apex in 26 (52%) patients were either mid-, late-, or pansystolic, and often associated with midsystolic click. Five (10%) patients had both types of murmurs. Diastolic murmurs were not heard in any patient. EKGs were normal in the majority. Cardiomegaly (C:T greater than 55%) was present in only 5 (10%) and dilatation of the main pulmonary artery in 2 (4%) patients. Thus the incidence of pseudoheart disease (PsHD) was small (14%). Echocardiograms were normal in 18 (36%) and abnormal in 32 (64%) patients. There was evidence of mitral valve prolapse (MVP) in 29 (58%) patients and 3 (6%) had evidence of bicuspid aortic valve (BAV). In a control group of 40 age- and sex-matched patients (26 male, 14 female, mean age 29.5 years), who also had heart murmurs but lacked straight upper dorsal spine, only 7 (17.5%) had MVP and none had BAV. The difference is both clinically and statistically significant (p less than 0.001). It is concluded that SBS is more often associated with valvular heart disease (MVP and BAV) than PsHD. Therefore, the diagnosis of SBS should remain presumptive until echocardiography has been performed to exclude MVP and BAV. SBS patients who have valvular heart disease should receive infective endocarditis prophylaxis.
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PMID:The "straight back" syndrome: current perspective more often associated with valvular heart disease than pseudoheart disease: a prospective clinical, electrocardiographic, roentgenographic, and echocardiographic study of 50 patients. 399 3

Prevention of infective endocarditis continues to concern health care providers in many specialties. The well-known lack of primary clinical trials in this area is not expected to change. Therefore, the evolution of recommendations and practice must be based on theoretic considerations and continuing assessment of secondary sources of information. Recent developments include a report of 52 cases in which antibiotic prophylaxis for infective endocarditis was attempted but appeared to fail. Most of these patients had undergone dental procedures after oral penicillin prophylaxis, with subsequent development of streptococcal endocarditis. In two thirds, the organism was sensitive to the antibiotic used. Notably, the most common underlying cardiac lesion among these patients was mitral valve prolapse. However, two recent independent analyses have concluded that providing endocarditis prophylaxis for all patients with mitral valve prolapse during procedures that might cause bacteremia would not be cost-effective. This is primarily because mitral valve prolapse is common and endocarditis is relatively rare, resulting in an adverse risk-benefit ratio. Parenteral prophylaxis for mitral valve prolapse might even cause a net loss of life from anaphylaxis. On the other hand, for the individual patient or physician, the reassurance provided by attempted prophylaxis with oral penicillin can be purchased at low cost and low risk. Very few cases of infective endocarditis have been reported after gastrointestinal and other endoscopic procedures; most of these do not need antibiotic coverage. Prophylactic antibiotics should be restricted to those situations in which both the procedure and the underlying cardiac condition seem to pose significant risk, for example, endoscopic sclerotherapy of esophageal varices in patients with prosthetic heart valves. Newly revised recommendations have been issued by the Medical Letter, the American Heart Association, and the American Dental Association. These regimens are shorter and simpler than earlier versions.
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PMID:Current issues in prevention of infective endocarditis. 401 77

The prevalence and clinical significance of aortic valve prolapse were determined prospectively in 2000 consecutive patients undergoing routine clinical cross sectional echocardiography. Two hundred and twelve patients were excluded because the aortic cusps were not adequately visualised. Aortic valve prolapse was defined as downward displacement of cuspal material below a line joining the points of attachment of the aortic valve leaflets. Twenty four cases of aortic valve prolapse (1.2%) were identified. The patients were aged 12-64 years and nine were women. All had underlying valvar heart disease and the commonest lesion (in 11 cases) was prolapse of the larger cusp in bicuspid valves. Aortic valve prolapse was seen in four patients with mitral valve prolapse (two with severe regurgitation), one of whom had marfanoid aortic root dilatation. The remaining examples of aortic prolapse were seen in patients with various disorders including one with pulmonary atresia, two with aortic root disease (one with dissection and one with idiopathic dilatation), and one case of severe mitral regurgitation. Valves destroyed by infective endocarditis were seen in two cases. Aortic valve prolapse may be detected in various cardiac disorders and does not imply the presence of aortic regurgitation, but when bicuspid aortic valves are present it may well be important in producing such regurgitation. Although aortic valve prolapse may be associated with severe forms of mitral valve prolapse, these patients rarely have aortic regurgitation.
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PMID:Prevalence and clinical significance of aortic valve prolapse. 401 27

Strict criteria were used to identify all definite, probable, and possible cases of endocarditis in residents of Olmsted County, Minnesota, from 1950 through 1981. The mean annual age- and sex-adjusted incidence rates per 100,000 person-years were 3.8 for total cases and 3.2 for definite and probable cases only. Total rates were 4.3 for 1950 through 1959, 3.3 for 1960 through 1969, and 3.9 for 1970 through 1981. Rheumatic heart disease was the underlying disorder in 26% of cases, with a shift noted during 1970 through 1981 to involvement of prosthetic rather than natural valves in these patients. Mitral valve prolapse was identified in 17% of cases. No source of infection could be identified in 41% of cases, including half of those cases with rheumatic or congenital heart disease. In cases diagnosed prior to autopsy, the 60-day fatality fell from 46% during 1950 through 1959 to 22% and 26% during 1960 through 1969 and 1970 through 1981, respectively.
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PMID:Infective endocarditis. Olmsted County, Minnesota, 1950 through 1981. 402 Oct 62

Many cardiac disorders can cause acute cerebrovascular insufficiency. The spectrum of potentially embolic cardiac conditions is wide; early recognition may determine a definite change in the management and prognosis of patients. In recent years the relevance of echocardiography in the screening of patients with cerebral ischemia has been emphasized. In order to identify potentially embolic cardiac conditions, 180 consecutive non selected patients with cerebrovascular insufficiency, underwent a clinical cardiological evaluation and an echocardiogram. The study population included 132 men and 48 women; the mean age was 51.7 years (range 19 to 72 years). A technically adequate echocardiogram was obtained in 153 patients. In 131 patients echocardiography was negative; cardiac lesions were detected in 22 patients (14.4%): mitral stenosis in 2, calcified aortic stenosis in 1, valvular endocarditis vegetations in 3, dilatative cardiomyopathy in 2, hypertrophic cardiomyopathy in 4, mitral valve prolapse in 4, regional left ventricular diskynesia in 5, mitral anulus calcification in 1. Patients were divided into 3 groups according to the results of cerebral angiography: 68 patients with normal angiography (Group I), 54 patients with atheromasic lesions on cerebral angiography (Group II), 31 patients in whom cerebral angiography was not performed (Group III). A higher incidence of cardiac diseases was found in the patients of Group I. The lack of lesions on cerebral angiography and the presence of embolic high-risk cardiac conditions strengthened a causal relationship of the cardiac disorder with cerebrovascular insufficiency in 10 of the 23 patients. In the mean follow-up period of 18 months of these 10 patients who underwent cardiac surgery or anticoagulation, no further attacks of cerebrovascular insufficiency were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cardiopathy and acute cerebrovascular insufficiency. Prospective study with two-dimensional echocardiography]. 404 42


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