CVS Pathology

Infective Endocarditis
By Ruto
• It is microbial invasion of heart valves and
endocardium forming vegetations.
• It is characterized by:
1. Fever,
2. Toxaemia,
3. Embolic phenomena,
4. Heart failure and
5. GN.
• It is fatal unless treated.
 Classification
It is classified into :
Acute endocarditis
• Highly virulent bugs attacks on normal valve.
• Half of patients die within days to weeks.
Subacute endocarditis
• Low virulence bugs colonizes abnormal valve
• Slow onset, long course, most recover.
• Symptoms: fever, flu-like symptoms
• Complications: septicemia, arrhythmias, renal
failure, systemic emboli.
 Acute IE
• Caused mainly by: staph aureus, streps pyogenes and
enterococci
• Features: Vegetations are larger>SAIE & localize at one
part of the valve. Composed of fibrin containing cluster
of bacteria and surrounded by polymorphs.
• Invasions cause necrosis and rupture
• Spread may cause myocarditis & aortic abscesses/
necrosis or rupture.
• Clinically: Features of acute infections, murmurs, positive
blood cultures, infarcts in brain, spleen or kidneys.
 Sub-acute IE
• Usually by bacteria of low virulence.
• Includes viridans, most normal flora, streps
bovis, s.epidermidis, diphtherioids, coliforms
bacilli, bacteroids, mycoplasma, coxiella
burnetii, fungal (i.v) aspergilosis, candida,
histoplasma.
• Morphology: friable soft shaggy thrombi of
variable sizes on the surface of contact of the
valves
• Spread may occur to the valve, chordae
tendinae, myocardium etc.
• They(vegetations/thrombi) consist of fibrin,
platelets & colonies of bacteria surrounded by
scanty polymorphs.
• Features includes:
1. Petechiae,
2. Splinter hemorrhages,
3. Splenomegally,
4. Cardiac murmurs,
5. Those resulting from infarcts
6. Featurs of GN.
7. HF due to valve
Infective endocarditis: vegetations on valve
Infective endocarditis: splinter hemorrhage of nail bed
 VEGETATIONS
• INFECTIVE >5mm
• NON-Infective <5mm
 DIAGNOSIS of IE

Diagnosis =MMm, Mmmm, mmmmm

Major Criterion
• Positive blood culture(s) indicating
characteristic organism or persistence of
unusual organism.
• Echocardiographic findings including valve-
related or implant-related mass or abscess, or
partial separation of artificial valve.
• New valvular regurgitation
Minor Criterion
• Predisposing heart lesion or intravenous drug use.
• Fever.
• Vascular lesions including: arterial petechiae,
subungual/splinter hemorrhages, emboli, septic
infarcts, mycotic aneurysm, intracranial hemorrhage,
Janeway lesions
• Immunologic phenomena including: glomerulonephritis,
Osler nodes, Roth spots, rheumatoid features
• Microbiologic evidence including: single culture showing
uncharacteristic organism
• Echocardiographic findings consistent with but not
diagnostic of endocarditis including: new valvular
regurgitation, pericarditis
 Non Infective Vegetations
• <5 mm
• Pericardial Effusion.
• Trousseau syndrome (migratory
thrombophlebitis with malignancies)
• s/p Swan-Ganz
• Libman-Saks with SLE (both sides of valve)