Paravalvular involvement in IE
- Abscess in 30 to 40%
- Extension into adjacent conduction tissues --> heart block
- AV and its adjacent annulus more susceptible
- AV ring overlies IVS --> proximal ventricular conduction system
- When to suspect? Conduction abnormalities on ECG and/or persistent bacteremia or fever
Posted 03/01/17 09:06:36 AM by Matthew Cummings
Early surgical consult in IE
- Persistent vegetation after systemic embolization
- Anterior MV or AV vegetation (>10mm), especially if mobile
- Difficult to treat pathogen (fungal, MDR)
- Valvular dysfunction --> Heart failure
- Usually MR or AI resulting in clinical HF
- Valve perforation/rupture
- Paravalvular extension w/ abscess, valve perforation, heart block
Posted 03/01/17 09:07:56 AM by Matthew Cummings
- S. aureus bacteremia: #1 risk factor is intravascular device
- IE occurs in up to 25% --> need TTE/TEE
- MSSA: β-lactams (oxacillin/nafcillin) >> vancomycin
- Non-life threatening PCN allergy: cefazolin
- Life-threatening: daptomycin/vancomycin
- IE: minimum 6 week antibiotic course
Posted 03/01/17 09:09:29 AM by Matthew Cummings
For further reading...
Posted 03/01/17 09:13:46 AM by Matthew Cummings
Created by Christopher Kelly
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