The pathophysiology of infective endocarditis comprises at least three critical elements: preparation of the cardiac valve for bacterial adherence, adhesion of circulating bacteria to the prepared valvular surface, and survival of the adherent bacteria on the surface, with propagation of the infected vegetation.
MID 9 Hemodynamics of Endocarditis Weinstein, Schlesinger NEJM, 1974 Bacteremia of Endocarditis Beeson et al., JEM, 1945.
The pathophysiology of infective endocarditis comprises at least three critical elements: preparation of the cardiac valve for bacterial adherence, adhesion of circulating bacteria to the prepared valvular surface, and survival of the adherent bacteria on the surface, with propagation of the infected vegetation. Please enable it to take advantage of the complete set of features! Developments in medical science and research in microbiology have contributed to a better understanding of the disease. Bacterial growth enlarges the vegetation, further impeding blood flow and inciting inflammation that involves the vegetation and adjacent endothelium. Nat Rev Cardiol. Trauma to the valve, however, produces an alteration in the endothelial cells, leading to either disruption of the surface and deposition of platelets and fibrin, or other phenomena that render the surface susceptible to colonization by circulating bacteria.
By continuing you agree to the Copyright © 2020 Elsevier B.V. or its licensors or contributors. For at least some streptococci, this occurs partly through perturbation of the valvular cells to produce tissue factor (tissue thromboplastin), which results in the deposition and growth of a fibrin-platelet clot over the rapidly growing bacterial colonies.We use cookies to help provide and enhance our service and tailor content and ads. The most common risk factors for infective endocarditis are previous heart damage, recent heart surgery or poor dental hygiene. 4 Bacteremia of Endocarditis Beeson et al., JEM, 1945 Bacterial Factors Involved in the Pathogenesis of Infective Endocarditis • Serum resistance - i.e.
Minor criteria are a predisposing heart condition or intravenous drug use, a fever, vascular or immunologic phenomena, or blood culture or echocardiogram changes that don?t meet major criteria. Once the surface is prepared, some bacterial strains appear to adhere to the fibrin-platelet matrix more avidly than others.
Author information: (1)AP-HP, hôpital Bichat, université Paris Diderot, DHU Fire, 75877 Paris, France. Bacterial endocarditis is a bacterial infection of the inner layer of the heart or the heart valves. The epidemiology of infective endocarditis has changed ; it occurs now in older patients and Staphylococcus has become the most frequent responsible microorganism. 2014 Sep;3(3):275-80. doi: 10.1177/2048872614523350. [Article in French] Iung B(1). This site needs JavaScript to work properly. Epub 2014 Feb 12. The incidence of infective endocarditis is markedly increased in patients with prosthetic heart valves and, particularly, in patients with prior infective endocarditis. The annual incidence of infective endocarditis is estimated around 30 cases per million inhabitants in population-based studies performed in western countries.
It appears that circulating bacteria do not readily adhere to normal endothelial surfaces.
The survival of bacteria adherent to the surface of the vegetation appears to be complex as well, requiring resistance in situ to the bactericidal properties of complement and phagocytosis by white cells.
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