Endocarditis

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Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Sex predisposition, Breed predisposition, Cost considerations, Special risks (e.g. anesthetic), Pathogenesis, Etiology, Predisposing factors, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Histopathology findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Subsequent management, Prevention, Prophylaxis, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Phil Fox DVM DipACVIM DipECVIM ACVECC
Dr Philip K Nicholls BVSc BSc PhD MRCVS FRCPath
Mr Simon Swift MA VetMB CertSAC MRCVS
Synonyms Bacterial endocarditis Valvular endocarditis Infective endocarditis Verrucous endocarditis

Introduction

  • Rare.
  • Cause : bacterial infection of the valves of the heart, usually mitral or aortic.
  • Results in valvular incompetence with vegetations or more rarely stenosis.
  • Signs : septicemia, infective thromboembolism or acute heart failure.
  • Diagnosis : blood culture (not always positive), ultrasonography and clinical signs.
  • Treatment : combinations of bacteriocidal antibiotics for a prolonged period.
  • Prognosis : generally poor.

Diagnosis

Clinical signs

  • Pyrexia which responds to antibiotics then recurs.
  • Systolic left sided apical murmur of mitral regurgitation (holosystolic grade 3-4/6) or rarely basilar representing aortic stenosis.
  • Diastolic murmur of aortic regurgitation - soft left sided, basilar, starting after S2 and decrescendo.
  • Arrhythmias - premature beats, heart block and tachycardias.
  • Signs of left heart failure: tachypnea or dyspnea, exercise intolerance, cough.
  • Bounding femoral pulses: due to aortic regurgitation.

Diagnosis

Differential diagnosis

  • Acquired heart disease:
    • Hypertrophic - cardiomyopathy  Heart: hypertrophic cardiomyopathy  , dilated - cardiomyopathy  Heart: dilated cardiomyopathy (DCM)  , restrictive - cardiomyopathy  Heart: restrictive cardiomyopathy  .
    • Hypertensive - cardiomyopathy  Hypertension  .
    • Thyrotoxic - cardiomyopathy  Hyperthyroidism  .
  • Systemic infection:
    • Septicemia/abscessation  Abscess  .
    • Feline infectious peritonitis (FIP)  Feline infectious peritonitis  .
    • Upper respiratory tract infection (URTI)  Viral-induced upper respiratory tract disease  .
    • Toxoplasmosis  Toxoplasmosis  .
    • Feline infectious anemia (FIA)  Feline infectious anemia  .
    • Myeloproliferative diseases.
  • Congenital heart disease  Congenital heart disease: overview  .

Sequelae

Prognosis

  • Depend on the virulence of the organism, severity of valvular damage and which valve is involved.
  • Generally has a poor prognosis.
  • Mitral valve endocarditis carries a better prognosis than aortic.
  • Cats who are FeLV  FeLV test  or FIV  FIV test  positive have a poorer prognosis.
  • Gram-positive infections carry a better prognosis than gram-negative because of the complication of endotoxemia.

Expected response to treatment

  • Control of heart failure.
  • Improved demeanor.

Reasons for treatment failure

  • Resistant bacteria.
  • Severe valve damage.
  • Long delay to diagnosis and treatment.

Sources

Publications

Refereed papers

  • Malik R, Barrs V R, Church D B, Zahn A, Allan G S, Martin P, Wigney D I & Love D N (1999)Vegetative endocarditis in six cats.J Feline Med Surg1(2), 171.
  • De Jonghe S, Ducatelle Ret al(1998)Verrucous endocarditis due to Escherichia coli in a Persian cat.Vet Rec143, 305-307.
  • Yamaguchi R A, Pipers F S & Gamble D A (1983)Echocardiographic evaluation of a cat with bacterial vegetative endocarditis.JAVMA183, 118-120.

Other sources of information

  • Caney S M A, Wotton P Ret al(1997)Valvular endocarditis in four cats.Proceeding of ACVIMLake Buena Vista, Florida pp 689.
  • Goodwin J K & Miller M W (1997)Infective endocarditis.In:Consultations in Feline Internal Medicine.Ed. J R August, W B Saunders. pp 273-278.
  • Thomas W P (1992)Update: infective endocarditis.In:Kirk's Current Veterinary Therapy XI.Ed R W Kirk & J D Bonagura, W B Saunders. pp 752-755.
  • Calvert C A (1988)Endocarditis and bacteraemia.In:Canine and Feline Cardiology.Ed P R Fox, Churchill Livingstone, pp 419-434.
  • Hawe R S (1980)Bacterial endocarditis, a review.In:Pet Practice.pp 1569-1579.

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