From the Guidelines
Infective endocarditis is most commonly associated with a regurgitant murmur, specifically a new or changing regurgitant murmur, as a result of valvular insufficiency caused by the infection. This type of murmur typically presents as a holosystolic or early diastolic murmur, depending on which valve is affected, such as the mitral or aortic valves, leading to mitral regurgitation or aortic regurgitation murmurs 1. The development of a new regurgitant murmur in a patient with symptoms such as fever, night sweats, weight loss, and other constitutional symptoms should raise suspicion for infective endocarditis. Some key points to consider include:
- The murmur occurs because the infection creates vegetations on heart valves that interfere with proper valve closure, leading to blood flowing backward through the valve 1.
- The physical examination often reveals a new heart murmur, most commonly due to valvular insufficiency, and evidence of heart failure or a myriad of potential embolic and inflammatory/immune-mediated sequelae 1.
- The clinical presentation of endocarditis is heterogeneous, with patients often presenting with acute heart failure due to severe valve destruction, but many presenting insidiously 1.
- Imaging, such as transthoracic echocardiography (TTE), is used to support the diagnosis by demonstrating vegetations of cardiac valves and, in complicated cases, paravalvular abscesses affecting native and prosthetic valves 1.
From the Research
Types of Heart Murmurs in Infective Endocarditis
The type of heart murmur associated with infective endocarditis can vary depending on the valve affected and the severity of the infection. Some common types of heart murmurs associated with infective endocarditis include:
- Mitral regurgitation: This is a common complication of infective endocarditis, particularly when the mitral valve is affected 2.
- Aortic regurgitation: This can also occur in infective endocarditis, especially when the aortic valve is involved 3, 4.
- Tricuspid regurgitation: This type of murmur can occur when the tricuspid valve is affected, often in cases of intravenous drug abuse 5.
Valve Regurgitation and Heart Failure
Valve regurgitation is a significant risk factor for heart failure in patients with infective endocarditis. Studies have shown that patients with left-sided valve regurgitation, such as mitral or aortic regurgitation, are at increased risk of developing heart failure compared to those without regurgitation 4. The risk of heart failure is higher in patients with moderate or severe regurgitation, and close monitoring is necessary to initiate timely surgery.
Surgical Intervention
Surgical intervention, such as valve replacement or repair, may be necessary in cases of infective endocarditis complicated by valve regurgitation or other complications. The type of surgery performed depends on the affected valve and the severity of the infection 2, 3, 6.