Infective Endocarditis: Identification and Management in the Emergency Department

Points and Pearls Excerpt

• More than 70% of infective endocarditis (IE) cases occur in native valves as a result of platelet aggregation due to valves that are damaged or have altered flow dynamics.
• Mitral valve prolapse is the most common risk factor and raises risk for IE 8-fold.
• Impurities in injectable drugs cause valvular damage, typically damaging the tricuspid valve through microtrauma. This area subsequently becomes a nidus for infection.
• Staphylococcus aureus is the leading cause of IE. Other major causes are Streptococcus viridans, enterococci, and coagulase-negative staphylococci. Blood-culture-negative IE accounts for one-third of cases.
• IE should be considered in any patient with > 1 week of fever that is consistent or intermittent.

Most Important References

• Moreyra AE, East S, Zinonos S, et al. Trends in hospitalization for infective endocarditis as a reason for admission or a secondary diagnosis. Am J Cardiol. 2019;124(3):430-434. (Retrospective; 21,443 patients) 
• Toyoda N, Chikwe J, Itagaki S, et al. Trends in infective endocarditis in California and New York state, 1998-2013. JAMA. 2017;317(16):1652. (Retrospective population study; 75,829 patients) 
• Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis. Eur Heart J. 2015;36(44):3075-3128. (Guideline) 
• Baddour L, Wilson W, Bayer A, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015;132(15):1435-1486. (AHA statement) 
• Pettersson GB, Coselli JS, Pettersson GB, et al. 2016 the American Association for Thoracic Surgery (AATS) consensus guidelines: surgical treatment of infective endocarditis: executive summary. J Thorac Cardiovasc Surg. 2017;153(6):1241-1258.e1229. (Guideline)