Ebook Feigenbaum’s echocardiography (8/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Feigenbaum’s echocardiography (8/E): Part 2
Ebook Feigenbaum’s echocardiography (8/E): Part 2
(. Chapter 13Infective EndocarditisInfective endocarditis remains a challenging and often fatal condition. One reason for this is the difficulty of es Ebook Feigenbaum’s echocardiography (8/E): Part 2stablishing an accurate diagnosis, particularly early in the course of the disease when proper management can be lifesaving. As therapeutic approaches have become more successful, the importance of early and accurate diagnosis is self-evident. Unfortunately, no single test or finding establishes the Ebook Feigenbaum’s echocardiography (8/E): Part 2 diagnosis in all cases. Instead, a constellation of findings that constitutes the diagnostic criteria continues to evolve.The central role that echocEbook Feigenbaum’s echocardiography (8/E): Part 2
ardiography plays in the diagnosis of endocarditis began in the early 1970s with the echocardiographic demonstration of a valvular vegetation by the M(. Chapter 13Infective EndocarditisInfective endocarditis remains a challenging and often fatal condition. One reason for this is the difficulty of es Ebook Feigenbaum’s echocardiography (8/E): Part 2anagement of these patients. Today, echocardiographic findings are a central pan of the diagnostic criteria for infective endocarditis.db CLINICAL PERSPECTIVEDespite improvements in therapy, infective endocarditis remains a potentially lethal disease with an incidence of 4 to 8/100.000 patient-years Ebook Feigenbaum’s echocardiography (8/E): Part 2. Although the overall incidence has not increased appreciably over time, several factors have contributed to substantial recent changes in the epidemEbook Feigenbaum’s echocardiography (8/E): Part 2
iology of the disease. For example, Staphylococcus aureus is now the most common cause of endocarditis in most series, in part due to an aging populat(. Chapter 13Infective EndocarditisInfective endocarditis remains a challenging and often fatal condition. One reason for this is the difficulty of es Ebook Feigenbaum’s echocardiography (8/E): Part 2 to the conceptof “healthcare contact” as a recognized risk factor for the development of infective endocarditis. Currently, approximately 25% of infective endocarditis cases in this country are attributable to a previous medical event or procedure, such as implantation of a prosthetic valve or pace Ebook Feigenbaum’s echocardiography (8/E): Part 2maker. More recently, the opioid epidemic that has plagued the United States has been associated with a striking increase in the incidence of drug-depEbook Feigenbaum’s echocardiography (8/E): Part 2
endence-associated endocarditis. Such patients appear to have a particularly poor prognosis, in part due to the likelihood of recurrent infection foll(. Chapter 13Infective EndocarditisInfective endocarditis remains a challenging and often fatal condition. One reason for this is the difficulty of es Ebook Feigenbaum’s echocardiography (8/E): Part 2essels, and within congenital defects. The vast majority of vegetations, however, occur on valve leaflets. Infection may also develop on any implanted or prosthetic material such as prosthetic valves, conduits, pacing electrodes, and catheters. The process of developing endocarditis occurs in the se Ebook Feigenbaum’s echocardiography (8/E): Part 2tting of bacteremia or fungemia. The initiating event usually requires the presence of a high-velocity jet, which may be due to a congenital anomaly sEbook Feigenbaum’s echocardiography (8/E): Part 2
uch as a ventricular septal defect, a regurgitant valve, or a prosthetic valve. It is thought that the jet interferes with the protective endothelial (. Chapter 13Infective EndocarditisInfective endocarditis remains a challenging and often fatal condition. One reason for this is the difficulty of es Ebook Feigenbaum’s echocardiography (8/E): Part 2ibrin, and other materials and become adherent to the endothelial surface to form a vegetation. The vegetation will grow in size, either as a sessile clump or as a highly mobile and even pedunculated mass with the potential for embolization. As the hallmark of endocarditis, the ability to detect the Ebook Feigenbaum’s echocardiography (8/E): Part 2 vegetation is the focal point of diagnosis. This sequence of events offers a mechanism for development of endocarditis in patients with underlying heEbook Feigenbaum’s echocardiography (8/E): Part 2
art disease. However, since as many as 50% of patients who get endocarditis do not have lesions associated with a high-velocity jet, some other set of(. Chapter 13Infective EndocarditisInfective endocarditis remains a challenging and often fatal condition. One reason for this is the difficulty of es Ebook Feigenbaum’s echocardiography (8/E): Part 2OFVEGETATIONrhe versatility of echocardiography in the evaluation of endocarditis is illustrated in Table 13.1. Among its important functions is the identification OÍ underlying heart disease known to increase a patient’s risk OÍ infection. Although the absence of underlying disease docs not confer Ebook Feigenbaum’s echocardiography (8/E): Part 2protection against endocarditis, particular conditions, such as congenital heart disease, bicuspid aortic valve, and a myxomatous mitral valve, arc knEbook Feigenbaum’s echocardiography (8/E): Part 2
own risk factors. At the same time, these conditions often confound the diagnosis of endocarditis by creating abnormalities that mimic or conceal echo(. Chapter 13Infective EndocarditisInfective endocarditis remains a challenging and often fatal condition. One reason for this is the difficulty of es Ebook Feigenbaum’s echocardiography (8/E): Part 2Although there are several manifestations of endocarditis, including abscesses and fistulae, the most common and direct evidence of infective endocarditis is the vegetation. Because a vegetation begins as a microscopic focus of infection and gradually grows into a conspicuous mass, its presence may Ebook Feigenbaum’s echocardiography (8/E): Part 2or may not be evident on an imaging study. Thus, echocardiography must be sensitive enough to detect the vegetation and specific enough to distinguishEbook Feigenbaum’s echocardiography (8/E): Part 2
it from other echocardiographic abnormalities or artifacts. As can be seen in Table 13.2, certain echocardiographic features can be used to either in(. Chapter 13Infective EndocarditisInfective endocarditis remains a challenging and often fatal condition. One reason for this is the difficulty of es Ebook Feigenbaum’s echocardiography (8/E): Part 2ached to the free edge of a valve leaflet. They tend to develop on the upstream side of the valve, that is, the ventricular side of the aortic valve and the atrial side of the mitral valve (Fig. 13.1). Vegetations may be sessile or pedunculated but usually have motion that is independent of the valv Ebook Feigenbaum’s echocardiography (8/E): Part 2e itself. Figure 13.2 is an example of endocarditis involving the tricuspid valve in a patient with a history of intravenous drug use. The infectiousEbook Feigenbaum’s echocardiography (8/E): Part 2
process can be seen encasing the valve leaflets and chordae. Severe tricuspid regurgitation was present. Because vegetations often occur in the path o(. Chapter 13Infective EndocarditisInfective endocarditis remains a challenging and often fatal condition. One reason for this is the difficulty of es Ebook Feigenbaum’s echocardiography (8/E): Part 2 is a classic feature of most vegetations, fn fact, the absence of mobility argues against the diagnosis and should suggest the possibility of an alternative diagnosis, including a healed vegetation. The shape and size of vegetations arc quite variable and may either increase (due to progression of Ebook Feigenbaum’s echocardiography (8/E): Part 2disease) or decrease (due to healing or embolization) over time (Fig. 13.3). Fungal vegetations tend to be larger thanthose caused by bacterial infectEbook Feigenbaum’s echocardiography (8/E): Part 2
ions, and those involving the tricuspid valve tend to be larger compared with vegetations that affect the aortic or mitral valve (Fig. 13.4).Table 13.(. Chapter 13Infective EndocarditisInfective endocarditis remains a challenging and often fatal condition. One reason for this is the difficulty of es Ebook Feigenbaum’s echocardiography (8/E): Part 2ases of suspected IEDetects complicationsAssesses hemodynamic consequencesSerial evaluation (assesses efficacy of therapy)Intraoperative assessment of extent of diseasePrognosis (risk of complications)Establishes new baseline after therapyRepeat/follow-up role:TEE (after positive TTE) in patients at Ebook Feigenbaum’s echocardiography (8/E): Part 2 high risk for complicationsRepeat TEE (after negative initial TEE) if clinical suspicion persistsRepeat TEE if suboptimal course during therapy (e.g.Ebook Feigenbaum’s echocardiography (8/E): Part 2
. clinical deterioration, persistently positive blood cultures, worsening physical examination)FIGURE 13.1. An example of a large, mobile vegetation o(. Chapter 13Infective EndocarditisInfective endocarditis remains a challenging and often fatal condition. One reason for this is the difficulty of es Ebook Feigenbaum’s echocardiography (8/E): Part 2eo 13-la®coming soon(. Chapter 13Infective EndocarditisInfective endocarditis remains a challenging and often fatal condition. One reason for this is the difficulty of esGọi ngay
Chat zalo
Facebook