Study note

Splinter haemorrhages and acute or postoperative endocarditis

THE CONTEXT

Endocarditis may produce peripheral clinical signs, a severe acute illness, or infection following heart valve surgery.

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Splinter haemorrhages may occur in endocarditis; the stated frequency is 10%.

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Acute endocarditis presents as a severe febrile illness with prominent, changing heart murmurs, valve dysfunction and petechiae.

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Clinical stigmata of chronic endocarditis are usually absent.

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Embolic events are common, and cardiac or renal failure may develop rapidly.

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Echocardiography may detect abscesses.

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Partially treated acute endocarditis behaves like subacute endocarditis.

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Unexplained fever after heart valve surgery may indicate postoperative endocarditis.

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Infection usually involves the valve ring and may resemble acute or subacute endocarditis, depending on organism virulence.

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Morbidity and mortality are high, and revision surgery is often required.

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Culprit organisms are often coagulase-negative staphylococci introduced during the perioperative period.

NEETx

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