Archive for the ‘infective endocarditis’ Category

Traditionally , vegetations are sine qua- non for diagnosing Infective endocarditis.

The following  are major criteria to diagnose IE

  1. Evidence for endocardial involvement in the form of  visible vegetation or New onset regurgitant murmur.
  2. Positive blood culture

There are six minor criteria .

To diagnose IE we need

  • Two major or
  • One major and 3 minor or
  •  5 minor criteria alone

Duke criteria for infective endocarditis



Now ,we realise  IE do  occur in the absence of visible vegetation.This happens because, vegetation can appear late, it is too  small and missed , burroughs inside tissue plane instead of entering cavity , may form  micro abscess or vegetation growth is prevented by prompt empirical antibiotics.

Final message

Vegetation is still a prime sign  to diagnosis of IE. However , please do not insist  on it .There can be significant endocardial infection  without formation of vegetation.The current criteria allows us to make a diagnosis of IE without documenting a clear cut visible vegetation.


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When do you call a infected heart as healed ?

Should the vegetation disappear to call it a cure ?

Vegetation’s rarely disappear following treatment . Very small vegetation may dissolve – 20% . Many times it regress in size .

Often  our aim should be  restricted  to sterilise the vegetation. This invariably happens in most of the patients who receive complete course of antibiotic. But healing and sterilizing is not enough in many vulnerable patients.If the vegetation is large the embolic risk is still there even with a healed vegetation.

So if there is a relatively large  (>1.5cm) vegetation it is always better to remove by surgery.

Interventional  techniques may   soon  allow  capturing these vegetation by basket catheters .When technology is there to retrieve small bits of a thrombus inside a coronary artery it should be possible to remove a large vegetation with temporary aortic filters in place.

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