Infective endocarditis in the elderly: diagnosis and management

Area of Science:

• Cardiology
• Infectious Diseases
• Geriatrics

Background:

• Infective endocarditis (IE) incidence rises in elderly patients.
• Contributing factors include population aging, improved survival with heart conditions, and increased use of medical devices.
• IE in older adults often lacks underlying structural heart disease, with atheromatous deposits and mitral annular calcification as key risks.

Purpose of the Study:

• To review the epidemiology, risk factors, clinical presentation, diagnosis, and management of infective endocarditis in older patients.
• To highlight specific challenges and considerations for IE in the geriatric population.

Main Methods:

• Literature review focusing on studies of infective endocarditis in patients aged 65 and older.
• Analysis of diagnostic modalities including transesophageal echocardiography and blood cultures.
• Review of current treatment strategies, including antibiotic therapy and surgical interventions.

Main Results:

• Older patients present with atypical symptoms, often lacking fever but exhibiting central nervous system manifestations.
• Enterococci and gastrointestinal bacteria are common causative agents.
• Transesophageal echocardiography offers high sensitivity (>90%) for vegetation detection.
• Blood cultures are diagnostic in 80%-99% of cases.
• Prolonged antibiotic therapy is frequently necessary.

Conclusions:

• Infective endocarditis in older adults requires tailored diagnostic and management approaches.
• Early surgical intervention for acute aortic regurgitation-induced heart failure is crucial.
• Valve replacement surgery is feasible with acceptable outcomes even in the very elderly.