Chest
Volume 66, Issue 2, August 1974, Pages 151-157
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Heart Failure in Infective Endocarditis: Predisposing Factors, Course, and Treatment

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A review of 144 episodes of infective endocarditis showed heart failure (HF) developing in 55 percent of patients; two-thirds of these had severe HF. HF developed in over 80 percent of patients with aortic valvular insufficiency and/or enterococcal infection, but in less than 20 percent of patients with congenital heart disease or tricuspid valvular infection. Half of the patients with mitral valvular insufficiency developed HF. Nearly 95 percent of those who developed severe HF within six months had some degree of premonitory HF within one month following admission; HF seldom developed de novo after six months. In patients with severe HF and mitral and/or aortic insufficiency, valve replacement was clearly superior to medical therapy alone, even when active infection was present. Because of the high mortality at operation in patients with uncontrolled severe HF, surgical intervention is recommended at the first signs that mild HF is worsening, regardless of the length of prior antibiotic therapy.

Section snippets

METHODS

The series comprises 139 patients seen at the University of California-affiliated hospitals from Jan. 1, 1963 to June 30, 1971.

General Characteristics of the Series

There were 144 episodes of BE which occurred in 139 patients; the general features of these patients and their illnesses are outlined in Table 1. This group of patients appeared to be comparable to other large series of patients with BE.1, 2, 3, 4, 5, 6 About one-half of the patients had preexisting congenital or rheumatic heart disease (CHD), and one-third of the patients had coexisting chronic disease such as diabetes mellitus, hepatic cirrhosis, or chronic alcoholism.

In 17 cases BE was

DISCUSSION

Heart failure as a complication of BE occurred in 55 percent of our patients, an incidence comparable to the 15–65 percent incidence found by others.2, 3, 4, 5, 6, 7,23 Our data indicate that the likelihood of developing HF can be predicted from the site of infection, and, to a lesser extent, the type of infecting organism. Over 80 percent of patients with AI and half of the patients with MI developed HF within six months of admission, while patients with tricuspid insufficiency and nonvalvular

ACKNOWLEDGMENTS

Doctors Robert M. Elashoff, Mervin Goldman, John Hutchinson, Milton Hollenberg, and Melvin Scheinman offered helpful criticisms. Ms. Beverly Hill is thanked for editorial assistance.

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    Manuscript received November 13; revision accepted February 7.

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