Endocarditis: Pathology review
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Endocarditis: Pathology review
Cardiovascular system
Cardiac arrhythmias
Atrioventricular block
Bundle branch block
Pulseless electrical activity
Atrial fibrillation
Atrial flutter
Atrioventricular nodal reentrant tachycardia (AVNRT)
Premature atrial contraction
Wolff-Parkinson-White syndrome
Brugada syndrome
Long QT syndrome and Torsade de pointes
Premature ventricular contraction
Ventricular fibrillation
Ventricular tachycardia
Cardiac tumors
Cardiac tumors
Shock
Shock
Vascular disorders
Arterial disease
Aneurysms
Aortic dissection
Angina pectoris
Coronary steal syndrome
Myocardial infarction
Prinzmetal angina
Stable angina
Unstable angina
Abetalipoproteinemia
Familial hypercholesterolemia
Hyperlipidemia
Hypertriglyceridemia
Coarctation of the aorta
Conn syndrome
Cushing syndrome
Hypertension
Hypertensive emergency
Pheochromocytoma
Polycystic kidney disease
Renal artery stenosis
Hypotension
Orthostatic hypotension
Lymphangioma
Lymphedema
Peripheral artery disease
Subclavian steal syndrome
Nutcracker syndrome
Superior mesenteric artery syndrome
Angiosarcomas
Human herpesvirus 8 (Kaposi sarcoma)
Vascular tumors
Behcet's disease
Kawasaki disease
Vasculitis
Chronic venous insufficiency
Deep vein thrombosis
Thrombophlebitis
Cardiovascular system pathology review
Acyanotic congenital heart defects: Pathology review
Aortic dissections and aneurysms: Pathology review
Atherosclerosis and arteriosclerosis: Pathology review
Cardiac and vascular tumors: Pathology review
Cardiomyopathies: Pathology review
Coronary artery disease: Pathology review
Cyanotic congenital heart defects: Pathology review
Dyslipidemias: Pathology review
Endocarditis: Pathology review
Heart blocks: Pathology review
Heart failure: Pathology review
Hypertension: Pathology review
Pericardial disease: Pathology review
Peripheral artery disease: Pathology review
Shock: Pathology review
Supraventricular arrhythmias: Pathology review
Valvular heart disease: Pathology review
Vasculitis: Pathology review
Ventricular arrhythmias: Pathology review
Assessments
Endocarditis: Pathology review
USMLE® Step 1 questions
0 / 9 complete
Questions
USMLE® Step 1 style questions USMLE
of complete
| Laboratory value | Result |
| Complete Blood Count, Serum | |
| Hemoglobin | 12.5 g/dL |
| Hematocrit | 40.5% |
| Leukocyte count | 18,100 /mm3 |
| Platelet count | 250,000/mm3 |
| Inflammatory Markers, Serum | |
| ESR | 44 mm/hr |
| CRP | 18 mg/L |
| Electrolytes, Serum | |
| Sodium | 131 mEq/L |
| Potassium | 3.6 mEq/L |
| Chloride | 94 mEq/L |
| Bicarbonate | 20 mEq/L |
| Calcium | 8.4 mg/dL |
Transcript
Content Reviewers
Two people came into the cardiology ward.
One of them was 25 year old Darren, who came in with a fever, chills and fatigue.
On the clinical examination, his fingernails had splinter hemorrhages and the palm of his hands had some erythematous flat lesions.
There were also some track marks on his forearm.
The other one is 75 year old Anna, who also had a fever and the same splinter hemorrhages and erythematous flat lesions that we previously saw.
On auscultation, a heart murmur was heard.
On her history, she said she was at the dentist 2 weeks ago.
Okay, so both people likely have endocarditis, or inflammation of the inner layer of the heart.
Remember that the heart’s wall is made up of three layers, the epicardium being the outermost layer, then the myocardium, and the endocardium, which is the layer that gets inflamed.
The inflammation can affect the heart valves, the mural endocardium or even prosthetic valves!
The most common cases of endocarditis are due to a microbial infection, and this is called infective endocarditis but in some cases, endocarditis can also be non-infective.
For non-infective endocarditis, the first step is usually damage to the endocardium.
Damage exposes the underlying collagen and tissue factor, which causes platelets and fibrin to adhere, which forms tiny blood clots.
This is called Nonbacterial Thrombotic Endocarditis or NBTE.
Tiny clots and fibrin can develop into vegetation, especially on the heart valves which damages them and makes it harder for them to open or close.
Although the exact cause of NBTE is unknown, it’s thought that a proinflammatory state where cytokines levels are elevated can increase clot formation.
This can happen with hypercoagulable states, like when there’s a malignancy, especially pancreatic adenocarcinoma.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Management Considerations in Infective Endocarditis" JAMA (2018)
- "Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications" Circulation (2015)
- "2015 ESC Guidelines for the management of infective endocarditis" European Heart Journal (2015)
- "Poor oral hygiene as a risk factor for infective endocarditis–related bacteremia" The Journal of the American Dental Association (2009)
- "Clinical Presentation, Etiology, and Outcome of Infective Endocarditis in the 21st Century" Archives of Internal Medicine (2009)
- "2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease" Journal of the American College of Cardiology (2017)
- "Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-analysis" Heart (2017)
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