ECHO 2013 / Clinical Decision Making Endocarditis and the Role of Echo
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Echo to diagnose IE
Anatomic echo features to identify and describe:
•Vegetations: Oscillating or nonoscillating tissue density on valve or endocardium or implanted material. Reflectance of myocardium. Chaotic/independent motion. Irregular, multi-lobulated. Define size and mobility.
•Destructive valve lesions: aneurysm, perforation, prolapse, degree of regurgitation or obstruction, chordae or pap muscle rupture, dehiscence of prosthesis
•Abscess formation/fistulization/pseudoaneurysm
Echo is not 100% specific for Infective endocarditis
Lambl’s excresence |
Papillary fibroelastoma |
•Chiari network (serpiginous, highly mobile, look at attachments)
58 yo gentleman s/p CABG, found to have pancreatic cancer. No cardiac symptoms. No infectious symptoms
TEE: “kissing” lesions
•Blood cultures negative, ESR negative, CBC wnl. Diagnosed with marantic endocarditis and treated with SC heparin.
s/p surgery, treatment with heparin, chemotherapy
Non-bacterial thrombotic endocarditis (NBTE) diagnosis of exclusion
•Marantic- marantikos- Greek “wasting away”
•Usually on normal valve; Non-invasive= may not evidence new murmur or regurgitation
•Along lines of valve closure, smooth or “warty” verrucoid vegetations
•Most commonly on MV >AV
•Thrombin and platelets
•Embolic risk (50% incidence)
•Risk factors: Rheumatic fever, adenocarcinoma (mucin producing), SLE, hypercoaguable state, trauma (catheters)
•Treat with SC or IV heparin and treatment of underlying condition
Echo is not 100% sensitive
•Negative TEE observed in 15% IE.
•Repeat examination if negative first evaluation, 7-10 days later.
•76 yo with advanced prostate cancer requiring multiple percutaneous nephrostomy tubes with multiple episodes of sepsis with E. faecalis and MRSA. s/p CABG. known aortic regurgitation, but no baseline echo at MSK.
TEE #1