SCCM Resource Library-Emergent Complications of Infective Endocarditis

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This document provides information on the emergent complications of infective endocarditis (IE). The complications discussed include neurologic, pulmonary, cardiac-perivalvular abscess, and cardiac-heart failure.<br /><br />Neurologic complications of IE are typically caused by infected thrombus or vascular infection leading to cerebral infarct. Manifestations can include ischemic stroke, hemorrhagic stroke, abscess, and mycotic aneurysm. Management involves holding anticoagulation or antiplatelet therapy for ischemic stroke, managing intracranial pressure and maintaining a target systolic blood pressure of 130-140 for hemorrhagic stroke, and prescribing antibiotics or performing surgery depending on the size of the abscess.<br /><br />Pulmonary complications of IE, specifically right-sided IE, can lead to abscess, pneumothorax, and acute respiratory distress syndrome (ARDS). Appropriate antibiotic therapy is recommended, and anticoagulation should be deferred in cases of septic pulmonary emboli. If intubation is necessary, a protective strategy for the right ventricle should be implemented.<br /><br />Cardiac-perivalvular abscesses can occur through direct extension from the valve and can manifest as conduction disease (complete heart block) or coronary compression leading to acute coronary syndrome. Monitoring electrocardiograms and placing temporary ventricular pacing (TVP) are management strategies for conduction disease. There is no standard therapy for acute coronary syndrome, but a low threshold for transesophageal echocardiography (TEE) should be maintained if PR prolonging on ECG.<br /><br />Cardiac-heart failure can result from valvular damage and regurgitant lesions, leading to aortic regurgitation, mitral regurgitation, and cardiogenic shock. Management involves diuresis to reduce left ventricular end-diastolic pressure and afterload reduction and inotropic support to improve stroke volume. In severe aortic regurgitation, avoiding diastole and considering inotropic agents or TVP may be needed. Indication for surgical evaluation should be considered.<br /><br />This resource is provided by third parties and is not endorsed by the Society of Critical Care Medicine.

Asset Subtitle

Cardiovascular, 2024, 0:10:00

Keywords

emergent complications

infective endocarditis

neurologic complications

pulmonary complications

cardiac-perivalvular abscess

cardiac-heart failure

infected thrombus

cerebral infarct

hemorrhagic stroke

septic pulmonary emboli

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