1. Heart -Pathology
Endocarditis
Infective Endocarditis
Feature
Acute IE
Sub-acute IE
Valve
Previously normal
Deformed
Organism
Highly virulent
(Staph. Aureus)
Less virulent
(Strep. viridans)
Course
Rapid progression
Slow
Out –come
Fatal
Recover
1
Dr. Krishna Tadepalli, MD, www.mletips.com

2. Heart -Pathology
Endocarditis
 Infective Endocarditis
 Prosthetic valves  Staph. epidermidis
 Clinical  Fever, Murmurs ( changing quality), hemorrhages
( flame shaped – splinter h.ages at nail beds, Roth spotsRetina), osler’s node – subcutaneous at finger pulps
 Morphology vegetations ( MC in left side- MV, AV,IV Drug
abusers – Right side, septic )
 Complications  Stenosis/Regrgitation, CHF, Bursting of
Prosthetic valves, septic emboli, Glomerulonephritis
 Diagnosis  Duke’s criteria ( serial Blood cultures,
Echocardiography findings)
 Prevention Prophylactic antibiotics in patients congenital
heart diseases and prosthetic valves
2
Dr. Krishna Tadepalli, MD, www.mletips.com

3. Heart -Pathology
Endocarditis
 Non bacterial Thrombotic Endocarditis
 Sterile vegetations/ thrombi
 Seen in debilitated patients
 Causes DIC & Mucinous adenocarcinomas
 SLE
 Libman – Sacks endocarditis
 Affects  mainly MV and TV
 Mechanism  Immunological ( like RHD)
 Morphology  Fibrinoid necrosis
 Location  vegetations on both sides of valve
3
Dr. Krishna Tadepalli, MD, www.mletips.com

4. Heart -Pathology
Artificial Valves
Types
Feature
Mechanical
Bioprosthesis
Material
Synthetic
Porcine aortic valve
Thromboembolism
Major problem
-
Structural damage
+
++++
4
Dr. Krishna Tadepalli, MD, www.mletips.com

5. Heart -Pathology
Carcinoid Heart Disease
 MC site of carcinoid tumor  Appendix
 Secretes Serotonin or 5-HT
 Serotonin from GI carcinoids  metabolized in liver
 no carcinoid syndrome
 If there are Liver metastasis  serotonin in venous
circulation  carcinoid syndrome
 Serotonin in Carcnoid syndrome pts. metabolized in
Lungs
 Only right side heart lesions
 Bronchial and Gonadal carcinoids, patients with Rt. to Lt.
heart shunts left heart lesions
 Features of carcinoid syndrome
5
Dr. Krishna Tadepalli, MD, www.mletips.com

6. Heart -Pathology
Carcinoid Heart Disease
Features of carcinoid syndrome
Vasodilatation  flushing of skin, face
GI Hyper motility  cramps, nausea,
vomiting, diarrhea
Heart  mainly Rt. Side valve
dysfunction ( due to thickening and Acid
MPS deposits)
6
Dr. Krishna Tadepalli, MD, www.mletips.com

7. Heart -Pathology
Carcinoid Heart Disease
Features of carcinoid syndrome
Vasodilatation  flushing of skin, face
GI Hyper motility  cramps, nausea,
vomiting, diarrhea
Heart  mainly Rt. Side valve
dysfunction ( due to thickening and Acid
MPS deposits)
6
Dr. Krishna Tadepalli, MD, www.mletips.com