Presentation depends on whether the disease is acute or subacute. An acute infective endocarditis patient usually presents with high fever, chills and rapid onset of heart failure symptoms or peripheral embolic phenomena. Associated complaints include fatigability, myalgia, night sweats, headache, anorexia, weight loss, dulled sensorium, back pain, pleuritic pain, cough or dyspnea. Other findings like right upper quadrant pain or abdominal postprandial distress are not uncommon. The physician must inquire about the existence of known congenital heart defects, about recent dental, surgical or other invasive procedures or intravenous drug use. The history of the disease helps differentiate between an acute and a subacute endocarditis episode: a subacute patient will usually be diagnosed about 6 weeks after the pathological process has started, whereas an individual suffering from acute endocarditis will be obligated to present sooner by dramatic symptoms.

Peripheral embolism may manifest as stroke [1], hemiplegia, hematuria, unilateral blindness, myocardial or pulmonary infarction. If the disease goes undiagnosed for a longer period of time, the physician will notice Janeway lesions, petechiae, splinter hemorrhages, Roth spots and Osler nodes, caused by immune-mediated vasculitis. Right-sided endocarditis sometimes presents in a similar manner to pulmonary empyema. Mycotic aneurysms suggest Pseudomonas aeruginosa etiology.

Internal cardiac defibrillators associated endocarditis patients have a two-fold higher mortality rate than single-chamber pacemaker endocarditis individuals [2]. Their disease is usually caused by coagulase-negative staphylococci [3]. Also, these cases may report accompanying pericarditis and mediastinitis signs, almost always along with fever. Signs of congestive heart failure, such as distended jugular veins or changes in previously known murmurs result from mitral valve involvement, which occurs in in eighty percent of methicillin-resistant Staphylococcus aureus endocarditis cases associated with dialysis catheters [4]. Additional findings may include splenomegaly, gallop or arrhythmia, pericardial or pleural rubs, rales, pallor, acute septic monoarticular arthritis or delirium.

Echocardiography is usually the first imaging method applied. Transthoracic and transesophageal can help in diagnosis. They are able to characterize the dimensions of the vegetations and their effect on the underlying structures, such as valvular regurgitation or rupture. Anterior myocardial abscesses are better observed with transthoracic echocardiography, while abscesses in other locations are visualized by transesophageal studies [5]. Embolization can be predicted to some extent, based on vegetation dimensions and echogenicity. Color Doppler echo can diagnose cusp perforation and valvular regurgitation apart and showcase intracardiac fistulas, especially when used in transesophageal views. Advanced harmonic imaging techniques add accuracy to these methods [6].

A thoracic radiograph showing pulmonary pyogenic abscesses suggest tricuspid endocarditis. Atrioventricular blocks and new interventricular conduction delays may be seen on the electrocardiogram and suggest a poor prognosis. Computer tomography is used to ascertain cerebral abscesses [7], but also to characterize vegetations and valvular anatomy [8].

Treatment of infective endocarditis typically involves prolonged courses of intravenous antibiotics tailored to the specific organism identified in blood cultures. In some cases, surgical intervention may be necessary to repair or replace damaged heart valves, especially if there is significant valve dysfunction, persistent infection, or risk of embolism. The choice of antibiotics and the need for surgery depend on the type of microorganism, the severity of the infection, and the patient's overall health.

The prognosis for infective endocarditis varies depending on several factors, including the causative organism, the presence of complications, and the patient's underlying health. With prompt and appropriate treatment, many patients can recover fully. However, the condition can be life-threatening, especially if diagnosis and treatment are delayed. Complications such as heart failure, stroke, and systemic embolism can worsen the prognosis.

Infective endocarditis is most commonly caused by bacteria, with Streptococcus and Staphylococcus species being the most frequent culprits. The infection often occurs when bacteria enter the bloodstream through activities such as dental procedures, surgery, or intravenous drug use. Individuals with pre-existing heart conditions, prosthetic heart valves, or a history of endocarditis are at higher risk.

Infective endocarditis is a relatively rare condition, with an estimated incidence of 3 to 10 cases per 100,000 people per year. It can affect individuals of any age but is more common in older adults. The incidence is higher in men than in women. Risk factors include congenital heart defects, rheumatic heart disease, prosthetic heart valves, and intravenous drug use.

The pathophysiology of infective endocarditis involves the colonization of the endocardium by microorganisms, leading to the formation of vegetations. These vegetations consist of bacteria, fibrin, and platelets and can cause local tissue destruction and systemic embolization. The infection can also trigger an inflammatory response, contributing to further damage to heart structures and systemic complications.

Preventing infective endocarditis involves minimizing the risk of bacteremia (bacteria in the bloodstream) in high-risk individuals. This can include maintaining good oral hygiene, as dental procedures can introduce bacteria into the bloodstream. Prophylactic antibiotics may be recommended before certain medical or dental procedures for individuals with specific heart conditions. Avoiding intravenous drug use is also crucial in reducing the risk.

Infective endocarditis is a serious infection of the heart's inner lining, primarily caused by bacteria. It presents with a range of symptoms, including fever and heart murmurs, and requires a thorough workup for diagnosis. Treatment involves antibiotics and sometimes surgery. The prognosis depends on various factors, including the timeliness of treatment. Understanding the etiology, epidemiology, and pathophysiology of the disease can aid in prevention and management.

If you suspect you have symptoms of infective endocarditis, it is important to seek medical attention promptly. Symptoms like persistent fever, fatigue, and unusual skin spots should not be ignored. Maintaining good oral hygiene and following medical advice for any pre-existing heart conditions can help reduce your risk. If you have a history of heart valve issues or previous endocarditis, discuss preventive measures with your healthcare provider.

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