A Tale of Two Valves: Differences in Right- and Left-Sided Infective Endocarditis

Today Dr. Xu brought us an excellent case which helped illustrate the differences in epidemiology, clinical manifestations, and treatment of left-sided vs. right-sided endocarditis. Some takeaways:

  • It's useful to frame right and left sided endocarditis differently
    • Studies are mixed regarding the incidence of right- vs. left-sided IE in IVDU; most would suggest that right-sided is more common
    • Two case series published in the last 40 years would suggest that morbidity and mortality (including incidence of CHF) is higher in right-sided IE
  • Staph aureus native valve infective endocarditis (NV-IE) confers more risk for embolic phenomena and CNS events
  • Patients with IE and CHF, severe AR or MR, or periannular extension have a class 1b recommendation for surgical intervention
  • When you see ST elevation in aVR, worry about global ischemia.

References: Prendergast et al. Circulation. 2010;121:1141-1152 Mills et al. Chest. Volume 66, Issue 2, August 1974, Pages 151-157 -- California Brown et al. Infective Endocarditis in the Injection Drug user. Infect Dis Clin N Am 16 (2002) 645–665 – Detroit Faber et al. Scand J Infect Dis. 1995;27(5):483-7. -- Danish Mathew et al. Arch Intern Med. 1995 Aug 7-21;155(15):1641-8. -- Chicago Miro et al. Clinical Infectious Diseases, Volume 41, Issue 4, 15 August 2005, Pages 507–514 Ruotsalainen et al. BMC Infect Dis. 2006; 6: 137. -- Finnish

Kang et al. N Engl J Med 2012; 366:2466-2473