培训课件_感染性心内膜炎英文.pptVIP

7/98 * Update onInfective Endocarditis Larry Baddour, MD University of Tennessee 7/98 * Pathogenesis Disruption of the endocardial layer as a complication of abnormal blood flow associated with underlying cardiac defect Bacterium-endothelium interaction with bacterial attachment and invasion of endothelial cells 7/98 * Epidemiology Underlying valvular abnormality predisposing to infective endocarditis rheumatic fevera common cause in the past mitral valve prolapsecurrently represents the most common underlying cardiac abnormality 7/98 * mitral valve prolapse risk for infective ednocarditis is ?5x-8x mitral regurgitation increases the risk leaflet redundancy with myxomatous degeneration is a frequent finding age 20 , female predominateage 20 , male accounts for 60%age 50 , male accounts for 68% 7/98 * Mitral Valve Prolapse and Infective Endocarditis Male Female Number of cases Rev Infect Dis 1986;8:117-137 7/98 * Coagulase-negative Staphylococci can produce native-valve endocarditis in mitral valve prolapse usually subacute, difficult to diagnose, and disregarded as a contaminant delay in diagnosis and treatment may account for the severe complications myocardial abscess formation valvular insufficiency requiring valve surgery death 7/98 * Prosthetic Heart Valve positive blood culture in hospitalized patients with underlying prosthetic valves can be a harbinger of endocarditis 43% patients with nosocomial bacteremia or fungemia had prosthetic valve infection a serious complication 7/98 * IV Drug Use Recurrent Polymicrobial Staph aureus accounts for the majority of cases of endocarditis tricuspid valve, either alone or in combination, us most often infected 7/98 * Predisposing Factors Polymicrobial Infective Endocarditis 7/98 * Polymicrobial Infective Endocarditisclinical features IV drug use is the predominant risk factor younger age (mean 36.5 years) 2/3 were male right-sided cardiac involvement in 60% streptococci more frequent than S. aureus