Emboli in infective endocarditis: the prognostic value of echocardiography

Article Abstract:

Endocarditis is the potentially life-threatening infection of one or more valves of the heart by microorganisms. Treatment consists of many weeks of intravenous antibiotic therapy, and frequently involves surgical replacement of the infected valve(s). Echocardiograms (ultrasound of the heart) can sometimes reveal the presence of detectable vegetations on the valves. These are visible collections of the infecting microorganisms and the inflammatory tissue they incite. Some investigators believe that echocardiographically visible vegetations are more prone to embolize, or break off and travel through the circulation until they lodge in a vessel and damage the organ supplied by the blocked vessel. The data supporting this theory are conflicting, however. A total of 207 patients with documented endocarditis involving their mitral or aortic (heart) valves or both were studied with echocardiograms, performed within 72 hours of the onset of effective antibiotic therapy, and then followed throughout their clinical courses. The rate of embolization was found to be slightly, but not significantly, higher in those patients who had visible vegetations. The patients were also classified by what microorganism was causing their endocarditis, and those with Streptococcus viridans infections were found to have a seven-fold greater risk of emboli when they had visible vegetations on echocardiogram. Interestingly, those patients with Staphylococcus aureus endocarditis had a 2.4 times greater risk of embolization than those with streptococcal infection, but the presence or absence of visible vegetations was not a determining factor. Whatever the organism causing the infection, the rate of embolization decreased markedly over time and with longer durations of therapy. This study suggests that the mere presence of visible vegetations on the heart valves does not predict which patients are at greatest risk of embolization, but should be taken in context with other factors, such as the particular microorganism involved. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Causes of, Complications and side effects, Embolism, Heart, Echocardiography, Endocarditis, Bacterial, Bacterial endocarditis

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Cardinal clinical signs in the differentiation of heart murmurs in children

Article Abstract:

Evaluation of heart murmurs by a pediatric cardiologist with echocardiogram assessment appears to be an accurate and cost effective strategy for distinguishing heart disease from benign murmurs. Some characteristic sounds of pediatric heart murmurs may help pediatricians determine whether a heart murmur warrants referral to a pediatric cardiologist. A group of 222 patients referred to a children's heart clinic for evaluation of a heart murmur were examined by a cardiologist and underwent an electrocardiogram and echocardiographic assessment. The cardiologists decided whether the child had heart disease and indicated how sure they were that they were correct without reference to the echocardiogram. While doctors were incorrect in some cases, in all those cases they had sufficient doubt that they would have ordered an echocardiogram. Six characteristics of heart murmurs were predictive of disease. Using them as criteria, referrals to cardiologists could be halved.

Diagnosis, Practice, Pediatric cardiology, Heart murmurs

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