Introductory Chapter: Endocarditis

*Michael S. Firstenberg*

### **1. Introduction**

Endocarditis a very complex and diverse set of problems and can include infectious and non-infectious diseases of the heart. The spectrum of problems includes vegetations on valves, fistulas and abscess cavities, and infections that develop on prosthetic materials such as pacemaker and defibrillator leads, prosthetic valves, intra-cardiac catheters, heart pumps, and any other type of intracardiac foreign material. The diagnosis and management of these problems can be quite challenging and will typically require an integrated multi-disciplinary team. Nevertheless, with advances in the therapies that are being offered to older and sicker patients, offset by advances in both the medical and surgical management of infectious cardiac problems, the number of cases continue to grow with still major risks for morbidity and mortality. In addition, the global concerns for substance abuse and the risks for the use of contaminated needles has led to a significant increase in associated infectious complications. Without a doubt, endocarditis in the setting of substance abuse is not only a significant medical and surgical problem – but a difficult social problem as well. The financial and ethical implications of endocarditis further highlight the emphasis of a teambased approach to the diagnosis and management.

Unfortunately, even minor invasive procedures have been shown to increase to risk of infections of native or prosthetic valves [1]. Typically, endocarditis was associated with blood-stream infections in the setting of dental procedures, but it is becoming more recognized that even minor procedures, such as gastrointestinal endoscopy, can increase risk for cardiac infections and might prompt a broader reevaluation of the role of prophylactic antibiotics prior to such procedures. Evidence, especially in higher-risk patients such as those with bicuspid aortic valves and mitral valve prolapse, is suggesting that the risk for bloodstream infection might be greater than historically believed [2].

The growing incidence of endocarditis also parallels the growing social problems of modern society as is seen in the evolving epidemiology of patients presenting with infections of their heart, heart valves, and intra-cardiac devices and structures. As mentioned, the global drug abuse epidemic – combined with the increasing utilization of cardiac procedures in older and sicker patients with advanced co-morbidities, reflects the need for a more wide-spread recognition of this problem. Fortunately, advances in diagnostic –especially imaging technology and microbiology serology testing – and surgical techniques can improve outcomes in those who present with even advanced disease. As such, the goal of this book is to emphasize and review some of the evolving concepts in the diagnosis, presentation, epidemiology, and management options of endocarditis.
