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[Right infectious endocarditis. Study of 30 cases]
Abstract:
Due to the lack of specificity of the clinical picture in the right-sided infective endocarditis, the correct diagnosis is rarely made. We reviewed 30 cases with right-sided or right and left infective endocarditis, treated in the INC from 1946 to 1982. The average age was 20 years. Rheumatic fever (53%), congenital heart disease (40%) and cardiac prostheses (7%) were the more common underlying diseases. The diagnosis was made on an average 7.3 months after the first symptom. Heart failure (93%), fever (76%), weight loss (73%), haemoptysis (66%) and general malaise (53%) were the predominant symptoms. There was no diagnostic suspicion in 9 patients (30%) and in 7 from 16 with negative blood culture, the infection was exclusively right-sided. Peripheral and pulmonary embolism was the most frequent complication. (66%) There were 29 deaths (96.6%). In all of them the diagnosis was confirmed in the postmortem examination. Heart failure and septic shock were the main causes of death. Almost all patients were infected with gram-negative germs and staphylococcus Aureus. This diagnosis should be suspected in a patient with known heart disease, who develops unexplained heart failure, moreover if pulmonary emboli are a feature. The diversity of the isolated germs is different from other publication that have shown staphylococcus as the most prevalent microorganism. This difference can be explained by the lack of drug abuse in our cases. The mortality rate is higher than in the left sided endocarditis.
Insights
Right-sided infective endocarditis is often misdiagnosed due to non-specific symptoms, leading to delayed diagnosis and high mortality. Early suspicion in patients with heart disease is crucial for timely intervention.
Area of Science:
- Cardiology
- Infectious Diseases
Context:
- Right-sided infective endocarditis presents with non-specific symptoms, complicating early diagnosis.
- This retrospective review analyzes 30 cases treated between 1946 and 1982.
Purpose:
- To highlight the diagnostic challenges and clinical characteristics of right-sided infective endocarditis.
- To identify common underlying conditions, predominant symptoms, and frequent complications.
Summary:
- The study found a significant delay in diagnosis (average 7.3 months) and a high mortality rate (96.6%).
- Predominant symptoms included heart failure, fever, weight loss, and pulmonary embolism.
- Commonly isolated microorganisms were gram-negative bacteria and Staphylococcus Aureus, differing from other studies possibly due to a lack of intravenous drug use in this cohort.
Impact:
- Emphasizes the need for increased clinical suspicion of right-sided infective endocarditis in patients with pre-existing heart conditions presenting with unexplained heart failure or pulmonary emboli.
- Suggests that the microbial spectrum may vary based on patient demographics and risk factors.
- Highlights the critical importance of early and accurate diagnosis for improving patient outcomes in infective endocarditis.