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Valve Disease
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
As already stated, the natural history of MVP is variable (Fig. 3.65). Complications include chordal rupture which is due to excessive mechanical stress operating on the thinned and elongated chords (seeFig. 3.59). This is particularly true of floppy valves associated with disorders of connective tissue such as Marfan's disease. Bacterial endocarditis is a risk in any floppy valve which has even mild regurgitation. The most contentious and least understood risk is that of sudden death (seeChapter 10). A rare complication is fusion of the chords onto the posterior wall of the left ventricle (seeFig. 3.64). The hypermobile cords hit the endocardium to produce vertical lines of endocardial fibrosis, which occasionally fuse together to produce a fibrous mass, which restricts upward movement of the cusp and alters the mechanism of regurgitation. The aim in mitral valve repair is to excise the most dome-shaped portion of the cusp and then stitch together the rest of the cusp, thus reducing its area and ability to prolapse (Fig. 3.66).
Cardiac conditions
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
In pregnancy, RHD can lead to heart failure (see Box 2.11) and pulmonary oedema (see Chapter 5), with or without arrhythmias. Management during pregnancy is aimed at identification, assessment and preventing/treating heart failure and pulmonary oedema. Volume status should be carefully monitored, and activity may need to be reduced. Bacterial endocarditis is a possible complication, so prophylactic antibiotics may be necessary. As it may recur in pregnancy, rheumatic fever prophylaxis may also be considered for women with RHD.
Common cardiac conditions, drugs and methods of assessment
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
In pregnancy RHD can lead to congestive heart failure (CHF) and pulmonary oedema, with or without arrhythmias. Management during pregnancy is aimed at preventing CHF. Volume status should be carefully monitored and activity may need to be reduced. Bacterial endocarditis is a possible complication, so prophylactic antibiotics may be necessary. As it may reoccur in pregnancy, rheumatic fever prophylaxis may also be considered for women with RHD.
Infection of cardiac prosthetic valves and implantable electronic devices: early diagnosis and treatment
Published in Acta Cardiologica, 2021
Lampros Lakkas, Burcu Dirlik Serim, Andreas Fotopoulos, Ioannis Iakovou, Argyrios Doumas, Ulku Korkmaz, Lampros K. Michalis, Chrissa Sioka
18F-fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging is a useful modality for the investigation of the aetiology of unknown origin fever, as it can differentiate infectious from other inflammatory and malignant conditions [6]. Bacterial endocarditis [7] due to infection of the CIEDs [8] represents frequent aetiologies of fever of unknown origin and may be difficult to diagnose [9]. Early diagnosis of infected CIEDs is warranted in order to control the infection with antibiotics and allow the subsequent early and safe removal of the CIED [10,11]. Scientific evidence suggests that early employment of FDG PET/CT may result in early diagnosis in patients with suspected CIED infection [12,13]. In addition, it may be utilised in order to monitor response to antibiotic treatment and/or consideration for altering drug combinations [7,14,15]. It may also differentiate CIED infection from early (up to 2 months) post implant residual background inflammatory changes that occasionally may occur [16].
A review of current treatment strategies for infective endocarditis
Published in Expert Review of Anti-infective Therapy, 2021
David Luque Paz, Ines Lakbar, Pierre Tattevin
Blood culture-negative endocarditis (BCNE) can be classified in three main categories: i) bacterial endocarditis with blood cultures sterilized by previous antibacterial treatment (usually due to classical endocarditis-causing bacteria, i.e. streptococci, more rarely staphylococci, or enterococci); ii) endocarditis related to fastidious micro-organisms (e.g. HACEK bacteria; defective streptococci – Gemella, Granulicatella, and Abiotrophia sp. – Propionibacterium acnes, Candida sp.): in these situations, prolonged incubation will allow the identification of the causative pathogen, in a few days; iii) lastly, the ‘real’ blood culture-negative endocarditis, due to bacteria non-cultivable in blood with the techniques currently available, primarily: Bartonella sp., Coxiella burnetti (both easily diagnosed by ad hoc serological tests), and Tropheryma whipplei (most commonly diagnosed by PCR on excised cardiac valves)[87]. Non-infective endocarditis, rare, are mostly marantic endocarditis, and the exceptional endocarditis related to systemic diseases (lupus, Behcet)[88].
Hospital incidence, in-hospital mortality and medical costs of pneumococcal disease in Spain (2008–2017): a retrospective multicentre study
Published in Current Medical Research and Opinion, 2021
The hospital incidence of pneumococcal diseases over the study period was 31.1 per 10,000 patients (95%CI, 22.1–40.1) for pneumococcal pneumonia, 10.3 per 10,000 (95%CI, 9.1–11.6) for bacteraemia, 4.5 per 10,000 (95%CI, 4.3–4.7) for pyogenic arthritis, 3.2 per 10,000 (95%CI, 3.0–3.3) for endocarditis, 0.96 per 10,000 (95%CI, 0.9–1.1) for meningitis and 1.7 per 100,000 patients (95%CI, −0.7 to 4.1) for peritonitis. The hospital incidence of pneumococcal pneumonia and meningitis displayed a decreasing trend over the study period (p = .002 and p = .003, respectively); whereas the hospital incidence of bacteraemia and pyogenic arthritis increased significantly (p = .001 and p = .004, respectively) (Figure 2(A)). No significant trends were identified in the incidence of bacterial endocarditis (p = .865), while data for peritonitis could not be evaluated.