《感染性心内膜炎》课件.pptVIP

7/98 * 美国自发性脑出血处理指南课件慢性鼻炎吃什么药好慢性鼻窦炎吃什中医中药治疗高血脂饮食保健资料子宫肌瘤合并胆囊炎围手术期护理中医药对冠心病稳定性心绞痛长期治疗价值 慢性单纯性苔藓痤疮白癜风教材课程 * Update onInfective Endocarditis Larry Baddour, MD University of Tennessee Pathogenesis Disruption of the endocardial layer as a complication of abnormal blood flow associated with underlying cardiac defect Bacterium-endothelium interaction with bacterial attachment and invasion of endothelial cells 7/98 * Epidemiology Underlying valvular abnormality predisposing to infective endocarditis rheumatic fevera common cause in the past mitral valve prolapsecurrently represents the most common underlying cardiac abnormality 7/98 * mitral valve prolapse risk for infective ednocarditis is ?5x-8x mitral regurgitation increases the risk leaflet redundancy with myxomatous degeneration is a frequent finding age 20 , female predominateage 20 , male accounts for 60%age 50 , male accounts for 68% 7/98 * Mitral Valve Prolapse and Infective Endocarditis Male Female Number of cases Rev Infect Dis 1986;8:117-137 7/98 * Coagulase-negative Staphylococci can produce native-valve endocarditis in mitral valve prolapse usually subacute, difficult to diagnose, and disregarded as a contaminant delay in diagnosis and treatment may account for the severe complications myocardial abscess formation valvular insufficiency requiring valve surgery death 7/98 * Prosthetic Heart Valve positive blood culture in hospitalized patients with underlying prosthetic valves can be a harbinger of endocarditis 43% patients with nosocomial bacteremia or fungemia had prosthetic valve infection a serious complication 7/98 * IV Drug Use Recurrent Polymicrobial Staph aureus accounts for the majority of cases of endocarditis tricuspid valve, either alone or in combination, us most often infected 7/98 * Predisposing Factors Polymicrobial Infective Endocarditis 7/98 * Polymicrobial Infective Endocarditisclinical features IV drug use is the predominant risk factor younger age (mean 36.5 years) 2