CHAPTER 22 Infective Endocarditis
This protean disease, whose salient features have been known for centuries, continues to pose major diagnostic and therapeutic challenges. Infective endocarditis predominantly affects cardiac valves and leads to local destruction with subsequent regurgitation. Embolism, especially to the brain, is the most feared extracardiac complication. Diagnosis rests on positive blood cultures and demonstration of vegetations by echocardiography. The rise of aggressive pathogens and the frequency of unfavourable clinical circumstances, such as presence of prosthetic valves or compromised immunocompetence, have resulted in more frequent and earlier surgical therapy. Although endocarditis is no longer uniformly fatal, outcomes are still characterized by high morbidity and mortality. The upcoming European Society of Cardiology recommendations for endocarditis prophylaxis hopefully will further improve disease prevention and management of patients at increased risk.
Chapter 28)
