infective endocarditis, cardiac masses, tumors, thrombi

bacteria in the blood stream that travels to the heart and causes infection and damage to the valves and the inner lining of the heart

infective endocarditis

infective endocarditis can manifest into a what

vegetation

bacterial pathogens entering the bloodstream

• staphylococcus aureus

• streptococcus viridans

• enterococci

symtoms for endocarditis

• fever

• fatigue

• chills

• joint/muscle pain

• dyspnea (shortness of breath)

• murmur

• cough

• petechiae (spots caused by minor bleeding from broken capillaries)

• osler nodes

what is used in order to diagnose infective endocarditis

duke criteria

major criteria

• positive blood cultures

• imaging evidence of cardiac involvement

minor criteria

• fever

• history of endocarditis

• valve replacement/repair

• IV drug use

2 major or

5 minor criteria or

1 major, 3 minor criteria

postive diagnosis

1 major, 1 minor criteria or

3 minor criteria

possible diagnosis

other confirmed diagnosis or lack of infection post antibiotic treatment

negative diagnosis

vegetation characteristics

• irregular mass

• small or big (small may be difficult to image, may need off axis views or TEE)

Echo characteristics for infective endocarditis

• attachment upstream side of the valve (atrial side of the atrioventricular valves, ventricular side of semilumar)

• motion that is more chaotic than normal valve movement

• M-mode: rapid oscillating motion

what happens when a vegetation is attached to the MV

• attached to the atrial side of leaflet

• prolapse into the LA in systole

• can be mistaken for myxomatous, flail leaflet

• or ruptured papillary muscle

what happens when a vegetation is attached to TV

• most common with IV drug users

• usually large vegetation

• most common bacteria (staphylococcus)

• can lead to pulmonary emboli

what happens when a vegetation is attached to the AV

• attached to the LVOT side of the valve

• can be mistaken for the nodule of arantius or lamb excrescence

cardiac complications from infective endocarditis

• vegetation

• abscess

• valve destruction

• fistula prosthetic valve dehiscence (detachment of the prosthetic valve in one or more areas of the annular ring)

• HF (secondary to severe regurgitation)

treatment for infective endocarditis

• high dose antibiotic treatment specific to the pathogen

• surgical replacement/repair of valves

• prophylactic antibiotics for future procedures

• medical therapy for symptoms

formerly known as mar antic endocarditis, most common form. Is a small, sterile fibrin/platlet vegetation on the valve leaflets, frequently associated with advanced cancer (mucin producing pancreatic or lung cancer) or chronic debilitating diseases

nonbacterial thrombotic endocarditis (NBTE)

associated with systemic autoimmune diseases, most commonly systemic lupus erythematous and anti phospholipid antibody syndrome. these vegetations can form on either side of the valve and can lead to damage. even without infection

Libman-sacks endocarditis

a form of NBTE where cancers create a hyper coagulable state, triggering the formation of sterile clot on heart valves

malignancy-associated endocarditis

while sometimes causing chronic damage, acute rheumatic fever involves sterile inflammatory valvular lesions resulting from an autoimmune reaction to streptococcal infection, not directed infection of the valve itself

rheumatic endocarditis

most common benign cardiac tumor

myxoma

common site of attachment for myxomas

• fossa ovalis

• RA

  • LV & RV

benign tumor that usually raises on valvular tissue, can cause distal embolization and is usually found on the downstream side of the valve

papillary fibroelastoma

benign tumor that has a cardiac mass on the inferior and superior potions of the interatrial septum that resembles a tumor, has soft fat cells and is dumbbell-shaped

lipomatous hypertrophy

malignant tumor that is rare and highly aggressive originating from the blood vessel lining of the heart, most commonly the right atrium

angiosarcoma

malignant tumor that usually is from the ileum or appendix, it effects the right side of the heart causing TV thickening, TR, and right heart failure

carcinoid heart disease

malignant tumor that comes from kidney cancer and can be long and extend into the IVC and even the RA

renal cell carcinoma

how to assess cardiac tumors

location, size, hemodynamics effects, and any associated findings

most common benign tumor of valves

fibroelastoma

which chamber is affected by metastatic tumors

right atrium