Right-Sided Infective Endocarditis

Abstract

Infective endocarditis (IE) at the right side represents the 5-10% of IE cases. It is more frequent in people with intravenous drug addiction (IVDA); however, there is another population susceptible to this infection; hemodialytic patients, intracardiac devices, and congenital heart diseases are included inside this group. Right-sided infective endocarditis (RSIE) has lower mortality than the left-sided infective endocarditis (LSIE). Common symptoms secondary to right-sided endocarditis are the respiratory symptoms characterized by a cough, hemoptysis, persistent fever, dyspnea, and chest pain. Echocardiography and blood cultures are the first tools to perform the diagnosis. The tricuspid valve is the main anatomical structure affected. Medical treatment with antibiotic therapy resolves the infection majority of the time; the surgical treatment is indicated in some cases, such as right-heart failure due to severe tricuspid valve regurgitation; inability to eliminate bacteremia or organism; resistance to culture-directed antibiotic treatment, within 7 days; and tricuspid valve vegetations >20 mm. RSIE implies a better prognosis than LSIE. Concomitant left-sided IE carries a worse prognosis than right-sided infection alone, due predominantly to its greater likelihood for invasion and abscess formation.

Right-Sided Infective Endocarditis

“…greater than 7 days) refractory to culture-directed antibiotics, and tricuspid valve vegetations greater than 20 mm in length. 1 While the patient presented here was only on day two of antibiotics, he did have a vegetation that was 29 mm in length which warranted surgical exploration.…”

“…Right-sided Infective Endocarditis (RSIE) represents 5-10% of all IE cases, making it a rare clinical entity. 1 It is most commonly found in patients with a history of intravenous drug use; however, it is also associated with patients on dialysis, or have intra-cardiac devices, congenital heart diseases or immunocompromised states. 1 The diagnosis of RSIE is often delayed because its signs and symptoms are relatively different than LSIE which is the specific target of the modified Duke's criteria.…”

“…1 It is most commonly found in patients with a history of intravenous drug use; however, it is also associated with patients on dialysis, or have intra-cardiac devices, congenital heart diseases or immunocompromised states. 1 The diagnosis of RSIE is often delayed because its signs and symptoms are relatively different than LSIE which is the specific target of the modified Duke's criteria. 2 The patient presented here satisfied both of the major criteria of positive blood cultures and endocardial involvement.…”

“…lower mortality of 3-30%) than LSIE (27-38%) given its lack of systemic circulatory involvement which can lead to invasion and abscess formation. 1 The mainstay of medical treatment is antibiotics; however, if refractory, surgery is indicated in cases of: right-sided heart failure (due to severe tricuspid regurgitation), persistent bacteremia (i.e. greater than 7 days) refractory to culture-directed antibiotics, and tricuspid valve vegetations greater than 20 mm in length.…”

Atención en salud y modernas prácticas de enfermería en el contexto de los países luso-hispanos

“…Health care and modern nursing practices in the context of Luso-Hispanic countries de la integralidad, el cual se hace presente en las prácticas asistenciales de salud de los países luso-hispánicos, cuyo enfoque es el acceso y la promoción del cuidado en todos los niveles de atención, de forma que transcienda la mera práctica curativa (2,3).…”