Incidence Rate of First Episode of Endocarditis in Denmark ... · PDF file2017-04-05 1...
Transcript of Incidence Rate of First Episode of Endocarditis in Denmark ... · PDF file2017-04-05 1...
2017-04-05
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Infective Endocarditis
NielsEskeBruunDept.Cardiology
Herlev-GentofteHospitalCopenhagenDenmark
Incidence Rate of First Episode of Endocarditis in Denmark
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Erichsen et al. Eur J Intern Med 2016
EchocardiographyinEndocarditis
• Echocardiography plays akey role intheassesment ofpatientswithorsuspected ofhaving infective endocarditis
• http://nbv.cardio.dk/endocarditis
EchocardiographyinEndocarditis
• Diagnosis• Assesment ofseverity• Prediction ofshort-termandlong-termprognosis• Prediction ofembolic risk• Managementofcomplications• Assesment during surgery• Follow-up• Screeninginbacteremia
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ENDOKARDITDiagnose
• Klinik• Bloddyrkningerm.m.• Ekkokardiografi
–CT,MR,scintigrafi,PET-CT–Molekylærbiologisketeknikker
Sekundærekliniskefundvedendocarditis
Symptom Percentage
Fever 88-100 %
Sweats and/or chills
13-58 %
Malaise and/or aches
20-45 %
Anorexia or weight loss
13-70 %
Finding Percentage
Cardiac murmur 80-100 %
Petechiae and/or splinters
14-32 %
Splenomegaly 11-68 %
Anemia 63-81 %
Leukocytosis 40-47 %
Clinical Picture in Endocarditis
Dahl and Bruun Expert Rev Cardiovasc Ther 2013
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Endocarditis andSLE– Libman-Sacksendocarditis
• Mitral valve replacement• Microbiological examinations:tissue cultures,microscopy,16sPCR:allnegative.
• Histology:Libman-Sacks
Endocarditis andSLE– Libman-Sacksendocarditis
• Mitral valve replacement• Microbiological examinations:tissue cultures,microscopy,16sPCR:allnegative.
• Histology:Libman-Sacks
All imaging resultsmust be evaluatedon the backgroundof clinical, microbiological and clinical laboratorydata !!
Thechangingpatternofendocarditis
• Fewerrheumaticvalvulardiseases• Morenormal,degenerativevalvesandprolaps
• Moreptt´swithintravenouscatheters,HIVandiv.Abusers
• IncreasingageofIEpatients• Changingpatternofmicrobiologicalagents– MoreStaphylocoocusAureus– Moreresistantbacteria– Morenosocomialinfections
• Moreinfectionofdevices
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Murdoch, Arch Intern Med 2009
ICE databasen
Øst-Danske endokardit database
Dahl A. et al. Phd 2016
Enterococcus faecalis
Danish PM register
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PatientnoII
• 52yearsoldmanwithBrugada´s syndrom• FirstICDin1996• SeveralchangesofICDlead• VTablationx3• Morethan100relevantshockfromtheICDunit
• Admittedwith12/12BCwithCONS,fever,tired
PatientnoII
• TTE– negative• TEE– negative• PET-CT
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Indications forEchogardigraphy insuspected IE
ESC GUIDELINES 2015
TTETOE
Native/ProstheticNative/Prosthetic
Sensitivity 70/50%96/92%
Specificity 90/85%92/90%
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