Bartonella henselae bacilli in cardiac valve of a patient with blood culture-negative endocarditis. The bacilli appear as black granulations.
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Infective endocarditis

Endocarditis is an inflammation of the inner layer of the heart, the endocardium. The most common structures involved are the heart valves. more...

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Endocarditis can be classified by etiology as either infective or non-infective, depending on whether a foreign micro-organism is causing the problem.

Infective endocarditis

As the valves of the heart do not actually receive any blood supply of their own, which may be surprising given their location, defense mechanisms (such as white blood cells) cannot enter. So if an organism (such as bacteria) establish hold on the valves, the body cannot get rid of them.

Normally, blood flows pretty smoothly through these valves. If they have been damaged (for instance in rheumatic fever) bacteria have a chance to take hold.

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Prophylaxis for Infective Endocarditis
From American Family Physician, 5/15/01 by Anne D. Walling

(Canada--Canadian Family Physician, November 2000, p. 2248.) Bacterial endocarditis usually involves damaged heart valves, but can occur on any area of damaged endothelium. The infection is typically caused by transient bacteremia from infection in other areas of the body, such as pneumonia, or from instruments used during dental or other surgery. Established bacterial endocarditis has a mortality rate of approximately 37 percent and can lead to significant morbidity among survivors. Patients at high risk of bacterial endocarditis include those with prosthetic heart valves, congenital heart disease and previous history of bacterial endocarditis. Patients with cardiomyopathy and acquired valvular disease are generally at moderate risk. Patients with pacemakers, history of coronary artery bypass surgery, functional heart murmurs and acquired valvular disease without dysfunction are typically at negligible risk (no greater than the general population). In such patients, prophylaxis is not recommended. Prophylaxis is recommended in patients with mitral valve prolapse when a murmur is present and/or echocardiography shows mitral regurgitation. Amoxicillin in a dose of 2 g administered one hour before the procedure is currently recommended. Clindamycin in a dose of 600 mg is recommended for patients who are allergic to penicillin. Current recommendations do not include a second dose of antibiotic following the procedure.

COPYRIGHT 2001 American Academy of Family Physicians
COPYRIGHT 2001 Gale Group

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