Endocarditis

Endocarditis predominantly affects the aortic and mitral valves; involvement of the tricuspid valve occurs in approximately one-fifth of cases and pulmonary valve involvement is rare. In the developing world rheumatic heart disease is the most common predisposing factor. In developed countries endocarditis is more common in older people with native valve disease and in patients with prosthetic valves and intracardiac devices (pacemakers and defibrillators). In these countries up to 50% of cases have no predisposing cardiac lesion and more cases are related to intravenous drug abuse and nosocomial infection related to invasive procedures. Mortality remains high (30%) despite advances in antimicrobial therapy and surgery, and at least 50% of cases require valve surgery. Early diagnosis, specialist management, and timely intervention are key to successful outcome.