Dermatología lo deriva a

cardiología. Porque ?
Vías de Entrada en Endocarditis:

Procedimientos dentales (forma más

común), extracciones dentales,
prótesis, puentes, frenos.
Riesgo alto en pacientes con pobre
higiene dental (ancianos, o con
inmunocompromiso, con policitemia
o gingivitis por nifedipina o DFH)
Endocarditis InfecciosaProfilaxis:

1.-Sin Anestesia o con Anestesia

Local: a) Amoxicilina 3 grs 1hr
antes del procedimiento
b) Eritromicina 1.5 grs 1hr antes y
0.5 grs, 6 hrs después
c) Clindamicina 600 mgs 1hr antes
Etiología en Endocarditis:

Estreptococo viridans (alfa hemolítico):

aproximadamente en el 50%
Estreptococo fecalis (enterococo): 10%
Estafilococo dorado y epidermidis: 25%
Etiología en Endocarditis:

Post cirugía cardiaca: Estafilococo

epidermidis, bacilo difteroide,
estreptococo microaerofílico.
Antibióticos bactericides IV y
varias semanas
Profilaxis endocarditis
Bacteria + frecuente?
Cultivos negativos
Endocarditis No infecciosa
 Endocarditis de libman sacks asociado
a;
Tratamiento;
Diagnóstico definitivo de Endocarditis:

B. Criterios Clínicos:
(1) Dos criterios mayores
(2) Un criterio mayor y 3 menores
(3) Cinco criterios menores
Evidencia de daño miocárdico:

A. ECO positivo para Endocarditis:

(1) Masa intracardiaca móvil,
(2) Abscesos
(3) Prótesis disfuncionante
Diagnóstico de Endocarditis:

CRITERIOS MAYORES:
(1) Hemocultivos positivos para E.I.
A. Microorganismos típicos:
En dos cultivos separados
(1) Estreptococo Viridans
(2) Estafilococo Dorado
Enterococo
Diagnóstico de Endocarditis:
CRITERIOS MENORES:
(1) Predisposición: alteraciones
valvulares o protesis , uso de drogas I.V.
(2) Fiebre: temperatura > 38°C
(3) Fenómenos vasculares:
Embolo arterial, infarto pulmonar
séptico, aneurisma micótico,
Diagnóstico de Endocarditis:

CRITERIOS MENORES:
(3) Fenómenos vasculares:
Nódulos de Osler, petequias,
manchas de Roth, lesiones de
Janeway
Splinter hemorrhages (Panel A) are normally seen under the
fingernails. They are usually linear and red Panel B shows
conjunctival petechiae.Osler's nodes (Panel C)are tender,
subcutaneous nodules, often in the pulp of the digits or the thenar
eminence.Janeway's lesions (Panel D) are nontender,
erythematous, hemorrhagic, or pustular lesions, often on the palms
or soles.
Hemorragias en astilla (uñas)
nodulos de osler
 Endocarditis
Fever is the most common symptom and
sign in patients with IE. Fever may be
low grade or intermittent.
Heart murmur. The onset of a new or
changing quality
Spleenomegaly: Peripheral ManifestationsSpleenomegaly is noted less
commonly today. The classic peripheral manifestations (e.g.,
petechiae, splinter or subungual hemorrhages, Osler’s nodes,
Janeway lesions, Roth’s spots) also are not often seen in the
modern era
 endocarditis
Fever in a patient with a PV; should
be considered endocarditis until
proven otherwise,

and echocardiography is indicated

when clinical suspicion is high.
A large vegetation caused by Candida albicans partially occludes the orifice
of a bioprosthetic valve B, A Starr-Edwards prosthesis, where this large
vegetation. 
 Dx Endocarditis
Diagnosis The possibility of IE must be considered in any
patient with known valvular heart disease and an
unexplained fever.

Endocarditis should be suspected in IV drug abusers who

present with fever, cough, and pleuritic pain

Echocardiographic evaluation should be performed in

any patient with clinically suspected IE
Despues de ecocardiograma
TT y TE;
 Tx
generally includes penicillin, ampicillin,
ceftriaxone, or vancomycin, often in
combination with an aminoglycoside
En que sitio del corazón es mas frecuente la endocarditis en drogadictos?
Cual bacteria predomina y que válvula la mas afectada en drogadictos?

IV drug abusers has a unique potency to

affect the right heart valves
Staphylococcus aureus causes more than
50% of endocarditis in drug abusers,
with more than 70% of those involving
the tricuspid valve.
Prosthetic valve endocarditis
early when symptoms begin within 60
days of surgery
Staphylococcus epidermidis is a
predominant cause of prosthetic valve
endocarditis diagnosed within 60 days
 endocarditis
Fiebre

Soplo cambiante
IE must be considered in any patient with
known valvular heart disease and an
unexplained fever
Splinter hemorrhages (Panel A) are normally seen under the
fingernails. They are usually linear and red Panel B shows
conjunctival petechiae.Osler's nodes (Panel C)are tender,
subcutaneous nodules, often in the pulp of the digits or the thenar
eminence.Janeway's lesions (Panel D) are nontender,
erythematous, hemorrhagic, or pustular lesions, often on the palms
or soles.
A previously healthy 48-year-old man presented to
the emergency department with acute onset of pain
in both flanks
During the preceding 6 months he had had an
unintentional weight loss of approximately 5 kg.
Numerous splinter hemorrhages were observed on
the fingernails of both hands. No cardiac murmur
was heard, but the abdomen was tender and the
spleen was palpable below the left costal margin.
Blood cultures were drawn, and antibiotic treatment
was initiated for suspected bacterial endocarditis. A
transesophageal echocardiogram showed mobile
echogenic foci on the tricuspid and mitral valves.
Antibióticos
Cirugia
Ejemplos de cirugía
Profilaxis Endocarditis: