AHA Guidelines on Endocarditis Diagnosis and Follow-up
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2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease[1]
Diagnosis and Follow-up
| Class I |
| "1. At least 2 sets of blood cultures should be obtained in patients at risk for IE (e.g., those with congenital or acquired VHD, previous IE, prosthetic heart valves, certain congenital or heritable heart malformations, immunodeficiency states, injection drug users) who have unexplained fever for more than 48 hours(Level of Evidence: B) or patients with newly diagnosed left-sided valve regurgitation.(Level of Evidence: C)" |
| "2. The Modified Duke Criteria should be used in evaluating a patient with suspected IE(Level of Evidence: B)" |
| "3. Patients with IE should be evaluated and managed with consultation of a multispecialty Heart Valve Team including an infectious disease specialist, cardiologist, and cardiac surgeon. In surgically managed patients, this team should also include a cardiac anesthesiologist (Level of Evidence: B)" |
| "4. TTE is recommended in patients with suspected IE to identify vegetations, characterize the hemodynamic severity of valvular lesions, assess ventricular function and pulmonary pressures, and detect complications(Level of Evidence: B)" |
| "5. TEE is recommended in all patients with known or suspected IE when TTE is nondiagnostic, when complications have developed or are clinically suspected, or when intracardiac device leads are present (Level of Evidence: B)" |
| "6. TTE and/or TEE are recommended for re-evaluation of patients with IE who have a change in clinical signs or symptoms (e.g., new murmur, embolism, persistent fever, HF, abscess, or atrioventricular heart block) and in patients at high risk of complications (e.g., extensive infected tissue/large vegetation on initial echocardiogram or staphylococcal, enterococcal, fungal infections)(Level of Evidence: B)" |
| "7. Intraoperative TEE is recommended for patients undergoing valve surgery for IE(Level of Evidence: B)" |
| Class IIa |
| "1. TEE is reasonable to diagnose possible IE in patients with Staphylococcal aureus bacteremia without a known source (Level of Evidence: B)" |
| "2. TEE is reasonable to diagnose IE of a prosthetic valve in the presence of persistent fever without bacteremia or a new murmur (Level of Evidence: B)" |
| "3. Cardiac CT is reasonable to evaluate morphology/anatomy in the setting of suspected paravalvular infections when the anatomy cannot be clearly delineated by echocardiography (Level of Evidence: B)" |
| Class IIb |
| "1. TEE might be considered to detect concomitant staphylococcal IE in nosocomial Staphylococcal aureus bacteremia with a known portal of entry from an extracardiac source (Level of Evidence: B)" |
References
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J. Am. Coll. Cardiol. 63 (22): 2438–88. doi:10.1016/j.jacc.2014.02.537. PMID 24603192.