Endocardial Disease

Question 1

Infectious endocarditis — definition and facts ?

Answer 1

Inflammatory reaction of the endocard after bacterial exposition 
Acute and subacute form (Staph. aureus / Strep. viridans)
diagnostic criteria (Duke criteria)

Question 2

Infectious endocarditis — aetiology ?

Answer 2

Development of endocardial vegetations preferably at the valves
Vegetations consists of thrombi, inflammatory cells, bacteria etc.

Question 3

Infectious endocarditis — typical pathogens ?

Answer 3

Staphylococcus aureus
Streptococcus pneumoniae, viridans
Enterococcus
HACEK Group

Question 4

Infectious endocarditis — clinical symptoms ?

Answer 4

intermittent fever, shivers (~90%)
loss of appetite, fatigue,
weight loss, arthralgias
pathological inflammatory parameters

Question 5

Infectious endocarditis — complications ?

Answer 5

acute valvular insufficiency
embolic events, organ failure
bacteraemia, septicaemia
paravalvular abscess, pseudoaneurysm, fistula

Question 6

Infectious endocarditis — therapy ?

Answer 6

empiric or targeted antibiotics
specific treatment of complications
surgery of (para-) valvular complications e.g. abscess, fistula

Question 7

Infectious endocarditis — prognosis ?

Answer 7

potentially life-threatening

in-hospital mortality ~15-30%, ~20-40% with prosthetic valve

Question 8

Infectious endocarditis — imaging (TTE) ?

Answer 8

method of choice
findings: vegetations, leaflet perforation, paravalvular abscess, paravalvular leakage, pseudoaneurysm, fistula
Duke criteria

Question 9

Infectious endocarditis — imaging (CT) ?

Answer 9

class 2a indication
findings: vegetations, leaflet perforation, paravalvular abscess, paravalvular leakage, pseudoaneurysm, fistula, prosthesis dehiscence

Question 10

infectious endocarditis — differential diagnosis (DDx) ?

Answer 10

abacterial non-infectious endocarditis
autoimmune endocarditis
hypereosinophilic endocarditis

Question 11

non-infectious endocarditis — definition ?

Answer 11

non-bacterial inflammation with vegetations on one or more valves and / or the adjacent endocard

Question 12

non-infectious endocarditis — diseases ?

Answer 12

rheumatic endocarditis
marantic endocarditis
Libman-Sacks endocarditis
Löffler endocarditis
carcinoid heart disease
rheumatoid arthritis associated

Question 13

rheumatic endocarditis — facts ?

Answer 13

most frequent form of endocarditis
usually ~2 weeks after ß-haemolytic streptococci infection
part of rheumatic fever (autoimmune reaction with possible pancarditis)
mitral valve most frequently involved (~34% MS, ~20% MI, ~46% cb)

Question 14

marantic (verrucous, thrombotic) endocarditis — facts ?

Answer 14

hypercoagulable state due to tumor decay

prevalence ~20% with tumor patients

Question 15

Libman-Sacks endocarditis — facts ?

Answer 15

associated with SLE (systemic lupus erythematodus)
~9% cardiac and ~7% valvular involvement
vegetations on valves, endocard and chordae tendineae
most frequent site: posterior leaflet of the mitral valve

Question 16

Löffler endocarditis — facts ?

Answer 16

cardiac involvement as part of a hypereosinophilic syndrome
endocardial thickening specifically the ventricular apex
possible involvement of papillary muscles with valve insufficiency
development of restrictive cardiomyopathy

Question 17

carcinoid heart disease — facts ?

Answer 17

associated with carcinoid syndrome
~60% develop endocarditis after 1-2 years
fibrin deposits on valve leaflets / cusps, chordae tendineae, papillary muscles and adjacent endocard
-> valve fixation and retraction of tricuspid and pulmonary valves
-> right sided heart failure

Question 18

endomyocardial fibrosis — facts ?

Answer 18

endocardial thickening in particular of the apex
associated with fibrotic changes
can also involve the inner third of the myocardium
often associated with ventricular thrombi
involvement of papillary muscles can lead to AV-valve insufficiency

Question 19

endomyocardial fibrosis — aetiology ?

Answer 19

somewhat unclear
tropical endomyocardial fibrosis
Löffler endocarditis

Question 20

endomyocardial fibrosis — clinical symptoms and therapy ?

Answer 20

diastolic and later systolic dysfunction
dyspnea, fatigue, pericardial effusion, ascites
no specific therapy, medical treatment of cardiac insufficiency
therapeutic option: surgical resection of endocard (only small numbers) — high perioperative mortality ~15-30%

Question 21

endomyocardial fibrosis — imaging (TTE) ?

Answer 21

initial imaging method
diastolic / systolic dysfunction — restrictive cardiomyopathy
left ventricular thrombus
AV-insufficiency

Question 22

endomyocardial fibrosis — imaging (MRI) ?

Answer 22

endocardial thickening of the left / right ventricles (apex)
depiction of fibrosis with LGE
depiction of apical thrombi
evaluation of the papillary muscles
assessment of AV-valve insufficiency