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Nonvalvular infections of the cardiovascular system
R A Kearney1, H J Eisen, J E Wolf
1Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
Insights
Nonvalvular cardiovascular infections, often linked to devices, present subtly and are diagnosed late. Early detection and intervention are crucial for improving outcomes in these uncommon but serious conditions.
Area of Science:
- Cardiology
- Infectious Diseases
- Vascular Surgery
Background:
- Nonvalvular cardiovascular infections are uncommon but pose significant risks.
- They often arise on damaged endocardium or vascular intima, frequently associated with intravascular devices like pacemakers and prosthetic grafts.
- Primary cardiac tumors, such as myxomas, can also be involved.
Purpose of the Study:
- To review risk factors associated with nonvalvular cardiovascular infections.
- To outline the clinical presentation and diagnostic challenges.
- To discuss current treatment strategies and outcomes.
Main Methods:
- A comprehensive MEDLINE search (1966-1993) was conducted for relevant English-language articles.
- Included studies covered myocardial abscesses, endocarditis, mycotic aneurysms, infected devices, graft infections, and atrial myxomas.
- Manual review of bibliographies and selection of case series, clinical studies, autopsy studies, and reviews with sufficient data.
Main Results:
- These infections commonly affect individuals over 50, with risk factors including cardiovascular disease, diabetes, and malignancy.
- Clinical presentations are often subtle, leading to delayed diagnosis, frequently requiring advanced imaging techniques.
- Complications include embolization, cardiac or vascular rupture, and pericarditis, with poor survival rates if diagnosed late.
Conclusions:
- The incidence of nonvalvular cardiovascular infections is expected to rise with increased use of implantable devices and prosthetics in the elderly population.
- Further research is essential to establish optimal diagnostic methods, treatment protocols, and preventive strategies.
- Improved diagnostic accuracy and timely intervention are critical for better patient outcomes.
Purpose:
To review the risk factors, clinical presentation, diagnosis, and treatment of nonvalvular infections of the cardiovascular system.
Data Sources:
A MEDLINE search of English-language articles from 1966 to 1993 relating to myocardial abscesses, mural endocarditis, infective endarteritis and mycotic aneurysms, infection of pacemakers and implantable defibrillators, prosthetic vascular graft infections, and infected atrial myxomas; manual review of article bibliographies.
Study Selection And Data Extraction:
Case series and single reports, prospective and retrospective clinical studies, autopsy studies, and reviews were selected if they contained sufficient information about the prevalence, clinical manifestations, microbiologic features, management, and outcome of nonvalvular cardiovascular infections.
Results:
Nonvalvular infections of the cardiovascular system most commonly occur on previously damaged endocardium or vascular intima and are usually associated with intravascular devices such as graft material or pacemakers. Rarely, they can involve primary cardiac tumors such as myxomas. Most patients affected are beyond the fifth decade of life. Risk factors include cardiovascular disease, diabetes mellitus, and malignancy. The sexes are affected equally. The clinical presentations of nonvalvular endovascular infections are subtle and diagnoses are difficult to make, often requiring not only a high index of suspicion but also the use of sophisticated radiologic techniques. Hence, for many of these infections, the diagnosis is made late in the course of the infection, and survival rates are poor. Complications include peripheral embolization, cardiac rupture, vascular aneurysm rupture, and pericarditis. Therapy frequently involves surgical intervention in addition to the use of antibiotics.
Conclusions:
Although uncommon, nonvalvular infections of the cardiovascular system will increase in frequency as the use of implantable devices and prosthetic materials increases in the elderly. Studies are needed to determine the most appropriate diagnostic methods, treatment regimens, and methods for prevention of these infections.
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