Sher Rehman, Ghulam Shabbier, Muhammad Shahid.
Clinical presentation of Infective Endocarditis.
J Postgrad Med Inst Jan ;16(1):55-63.

In order to determine demographic characteristics, various modes of presentations and distribution of clinical findings, frequencies of different valves involved, special risk factors and complications of infective endocarditis in our population, this study was conducted between September 2000 and July 2001 in the Department of Medicine Khyber Teaching Hospital Peshawar, all patients having clinical suspicion of infective endocarditis were admitted and worked up. Out of seventy patients screened, thirty were selected fulfilling one of Duke criteria for clinical diagnosis of definite infective endocarditis. Thirty admitted patients having definite infective endocarditis as per Duke criteria were included. There were 21(70%) males and 9 (30%) females. Mean age of the patients was 24 years. Ninety percent of the patients were below 40 years of age. The commonest symptoms observed were fever, shortness of breath, arthralgia/myalgia, chills, anorexia, and malaise. The most common signs were fever, cardiac murmur, anemia and splenomegaly. High ESR, anemia and RA factor positivity topped the list of investigations. A definite predisposing factor of bacteremia could be identified in only 6 (20%) patients. Chronic rheumatic heart disease was the most common underlying cardiac predisposing condition 19 (30%), followed by congenital heart disease and mitral valve prolapse. Mitral valve was affected by vegetation in 18 (60%) patients, followed by aortic and tricuspid valves. Twelve patients had complications during the course of their illness. Prior use of antibiotics and lack of positive blood culture prevents most of the physicians making a definitive diagnosis of infective endocarditis. Hundred percent of our patients had underlying cardiac lesion to predispose them to infective endocarditis. Most of the patients belonged to younger age group. Male predominance was confirmed. ASD and MVP may be considered important risk factors in our population. A preceding procedure may not be identified in majority of the patients. Most of the symptoms, signs and laboratory investigations were in conformity to world literature.

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