Infective endocarditis continues to be a challenge for the cardiac physicians.
While we have innovated too much( More than what is required !) in the interventional arena little is progressed in the last few decades on this vital area of “Infections of heart”.
Globally , deaths continue to occur in prime ages due to rampant infections of the heart valves.
Prevention of IE was recently deglamorised by diluting the criteria for prophylaxis by ACC/AHA (Cost issues , overwhelming science ? )
So, what is left in the war against IE ?
Early diagnosis and recognition
How to diagnose it early ?
Suspicion is the key . . .
When to suspect ?
Suspect in all with fever and h/o heart disease . So far no case of afebrile IE reported !
Get rid of the common myths
- You don’t require vegetations to diagnose IE
- Blood culture need not be positive
- Fever can be low grade
- Rarely severe fatigue is the only sign
This effectively means , one can diagnose IE without a major criteria of Dukes.
One can diagnose IE with 5 minor criterias
If you wait for a major criteria to develop to start treatment , it could be a costly miss .
So have a open mind, suspect IE, treat early.
Do not unduly worry about , overuse of antibiotics in case of false diagnose of IE.This attempt is worth in weight of gold !
Million ton of antibitics are used indiscrininately in this world by all walks of physcinas for simple cold and surgeions non existing peripopertaive infections .
While , the global medical community has accepted this concept with total submission (Intentional harm condoned !) , it is funny to ask for 100% appropriateness in the therapy for a deadly infection of heart.
It is absolute necessity to inject an anticipatory antibiotic in all cases of suspected IE with high risk valve lesions. (Of course , it need to be a reasonably appropriate antibiotic with microbiologists consultation to avoid interference in the subsequent culture evaluation !)
Minor only infective endocarditis.
Please note IE can be diagnosed with the following 5 minor criteria
- Predisposing lesion
- Fever >38c
- Immunological / Vascular lesion
- Culture eqivocal
- No clear cut vegetation , but high suggestion of vegetaion, New valve regurgitation
A related article in this blog
Never hesitate to start empirical antibiotic therapy in suspected high risk IE
Let us err . . . for the patient’s sake !
Fever + New murmur*= IE until proven otherwise (Oxford handbook of clinical medicine P 136 7th Edition )
*It can be read as , presumably new murmur to increase the sensitivity.