update on the prevention, diagnosis and management of ... day/session 2/update on the prevention,...
TRANSCRIPT
![Page 1: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/1.jpg)
Update on the prevention, diagnosis and management of Infective
Endocarditis (IE)
Dr.Ahmed Yahya Mohammed Alarhabi MD, MsC,FcUSM,FACC,MAHA
Consultant Interventional Cardiologist Head of Cardiac Center
HUST
![Page 2: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/2.jpg)
ACC/AHA
![Page 3: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/3.jpg)
![Page 4: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/4.jpg)
![Page 5: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/5.jpg)
IE has the proclivity to cause complications both at the cardiac valve site and at extracardiac locations that can predispose affected patients to serious morbidity and mortality. It is for these reasons that management of IE requires a team approach, which generally includes specialists in infectious diseases, cardiovascular medicine, and cardiovascular surgery with particular expertise in IE. Thus every patient with IE should be managed in the inpatient setting of a medical center with experienced medical and surgical specialists to provide care, which often includes emergent diagnostic and surgical interventions.
Introduction
![Page 6: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/6.jpg)
Infective Endocarditis (IE)
• IE is an infection of the endothelial lining of the heart valves, mitral or tricuspid chorda tendinea, valve annulus, and aortic root.
• Pre-existing heart disease is found in 2/3 of the cases of left-sided IE.
• 1/3 patients have normal or clinically unrecognized valve disease.
• 3.6 to 7.0 cases/100,000 patient-years
![Page 7: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/7.jpg)
Distribution of Types of IE
• Isolated AV IE is observed in 55-60% of cases.
• Isolated MV IE occurs in 25-30% of cases.
• IE of both valves occurs in 15% of cases.
• Prosthetic valve IE constitutes 10-25% of all cases of IE. – Prosthetic valve IE is more common with prosthetic AV, multiple
valves, and after replacement of an infected native valve
The Ultimate Echo GuideRoldan CA.
![Page 8: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/8.jpg)
Distribution of Types of IE
• Right-sided IE constitutes 5-10% of all cases.
– 80% TV is involved
– Most commonly associated with IVDU
– Also occurs in patients with right heart wires or catheters.
• What is the incidence of culture-negative endocarditis?
– 5-10%
The Ultimate Echo GuideRoldan CA.
![Page 9: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/9.jpg)
![Page 10: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/10.jpg)
IE Cont. Def.
• Acute – Toxic presentation
– Progressive valve destruction & metastatic infection developing in days to weeks
– Most commonly caused by S. aureus
• Subacute – Mild toxicity
– Presentation over weeks to months
– Rarely leads to metastatic infection
– Most commonly S. viridans or enterococcus
![Page 11: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/11.jpg)
![Page 12: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/12.jpg)
![Page 13: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/13.jpg)
![Page 14: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/14.jpg)
![Page 15: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/15.jpg)
![Page 16: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/16.jpg)
![Page 17: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/17.jpg)
![Page 18: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/18.jpg)
![Page 19: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/19.jpg)
Infective Endocarditis
• Pathogenesis
Endothelial damage
Platelet-fibrin thrombi
Microorganism adherence
![Page 20: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/20.jpg)
Pathophysiology
• Local destructive effects • Valvular distortion/destruction
• Chordal rupture
• Perforation/fistula formation
• Paravalvular abscess
• Conduction abnormalities
• Purulent pericarditis
• Functional valve obstruction
![Page 21: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/21.jpg)
Pathophysiology
• Embolization • Clinically evident 11 – 43% of patients
• Pathologically present 45 – 65%
• High risk for embolization » Large > 10 mm vegetation
» Hypermobile vegetation
» Mitral vegetations (esp. anterior leaflet)
• Pulmonary (septic) – 65 – 75% of i.v. drug abusers with tricuspid IE
![Page 22: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/22.jpg)
Clinical Features
• Interval between index bacteremia & onset of sx’s usually < 2 weeks
• May be substantially longer in early PVE
• Fever most common sign • May be absent in elderly/debilitated pt.
• Murmur present in 80 – 85% • Generally indication of underlying lesion
• Frequently absent in tricuspid IE
• Changing murmur
![Page 23: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/23.jpg)
Braunwald 10th edition , 2015
![Page 24: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/24.jpg)
![Page 25: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/25.jpg)
Braunwald 10th edition, 2015
![Page 26: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/26.jpg)
Braunwald 8th Edition
![Page 27: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/27.jpg)
PVE commonly extends beyond the valve ring into the annulus which can cause dehiscence, paravalvular regurgitation and
conduction disturbances.
Braunwald 8th Edition
![Page 28: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/28.jpg)
Janeway Lesions
![Page 29: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/29.jpg)
Splinter Hemorrhage
![Page 30: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/30.jpg)
![Page 31: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/31.jpg)
Subconjunctival Hemorrhages
![Page 32: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/32.jpg)
Roth’s Spots
![Page 33: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/33.jpg)
![Page 34: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/34.jpg)
Echo.Cont.
• TTE sensitivity
– Vegetation <5mm 25%
– Between 6-10mm 70%
• TEE sensitivity 90-100%
• Prosthetic endocarditis
– TEE >> TTE
Evangelista Heart 90: 614-617 (2004)
![Page 35: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/35.jpg)
![Page 36: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/36.jpg)
![Page 37: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/37.jpg)
![Page 38: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/38.jpg)
Evangelista Heart 90: 614-617 (2004)
BMJ Vol. 333, Aug. 2006
![Page 39: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/39.jpg)
Evangelista Heart 90: 614-617 (2004)
BMJ Vol. 333, Aug. 2006
![Page 40: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/40.jpg)
BMJ Vol. 333, Aug. 2006
![Page 41: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/41.jpg)
Subaortic Complications of AV Endocarditis
![Page 42: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/42.jpg)
Braunwald 10th edition, 2015
![Page 43: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/43.jpg)
Braunwald 10th edition, 2015
![Page 44: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/44.jpg)
![Page 45: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/45.jpg)
![Page 46: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/46.jpg)
![Page 47: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/47.jpg)
![Page 48: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/48.jpg)
![Page 49: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/49.jpg)
![Page 50: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/50.jpg)
![Page 51: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/51.jpg)
![Page 52: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/52.jpg)
![Page 53: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/53.jpg)
![Page 54: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/54.jpg)
![Page 55: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/55.jpg)
![Page 56: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/56.jpg)
![Page 57: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/57.jpg)
![Page 58: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/58.jpg)
![Page 59: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/59.jpg)
![Page 60: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/60.jpg)
![Page 61: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/61.jpg)
![Page 62: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/62.jpg)
![Page 63: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/63.jpg)
![Page 64: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/64.jpg)
![Page 65: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/65.jpg)
![Page 66: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/66.jpg)
Conclusions
• The epidemiology of IE has changed in developed countries.
• TEE has a 95% sensitivity in detecting vegetations and is also key in finding complications of vegetations.
• Moderate to severe heart failure and vegetation length are important indications for surgery.
• Antibiotic prophylaxis regiman for IE was updated in 2007.
![Page 67: Update on the prevention, diagnosis and management of ... day/Session 2/Update on the prevention, diagnosis and...Infective Endocarditis (IE) •IE is an infection of the endothelial](https://reader034.vdocuments.mx/reader034/viewer/2022042018/5e76242cd77782464602d885/html5/thumbnails/67.jpg)
Thank you for attention