Two-dimensional echocardiographic observations in patients with clinical diagnosis of active infective endocarditis at Kenyatta National Hospital

Abstract

The sensitivity and clinical relevance Qf 2-dimensional echocardiographic presence of vegetations were examined proepectively in patients with cl nical diagnosis of active infective endocarditis at Kenyatta National Hospital, NairObi. A pattern of echocardiographic vegetations was present in 45% of the 40 patients diagnosed clinically to have active infective endocarditis. The major criteria for clinical diagnosie in these 40 patients included the presence of fever (manifested by chills, sweating, shivering and rigors) 8o%, Toxaemia (manifested by malaise, tiredness, weakness, anorex:a with generalised aches and pains) 77.5%, Cardiac murmurs 100%, congestive cardiac failure 80% and Pyrexia (Temp> 3aoe) 62.5%. 77.5% of the cases had rheumatic valvular heart disease. Blood cultures were positive in 37.1% of the patients, with staphylococCi being the commonest isolate. Only 30.8% of patients with bacteriologically proven endocarditis had vegetations on ultrasound whereas 54.5% of patients with negative blood cultures had vegetations at ultrasound. 47.5% of thE patients had antibiotic therapy prior to diagnosis, which was significantly correlated to the presence of bacteriologically negative cultures. The case fatality rate was 37.5% and was significantly related to the presence of severe CCF, and Renal insufficiency. The presence of vegetations on ultrasound in this series had no prognostic implications in so far as CCF, major emboli or death were concerned.