Thread by @DavidWienerMD

Not All Vegetations Are Infective: Tweetorial on Non Infectious Endocarditis

2 forms
▪Verrucous (Libman-Sacks)
▪Non-Bacterial Thormbotic Endocarditis (NBTE, “marantic”)

Both have thrombotic component & embolic potential
Data from @ase360 guideline below

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Who were Libman and Sacks?

Emanuel Libman (1872-1946)
▪Child of Polish Jewish immigrants
▪MD: Columbia
▪Skilled clinician & bacteriologist at Mt. Sinai Hospital. NYC
▪Patients included Albert Einstein and the actress Sara Bernhardt
▪President of the AMA

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▪Like Osler, developed technique of blood cultures
▪Coined the term subacute endocarditis
▪Identified s. viridans as a causative agent
▪Interest in infectious endocarditis led him to describe non-infectious form for which he is better known (Ann Int Med 1924;33:701-737)

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What is Libman’s connection with the composer and conductor Gustav Mahler?

▪Mahler was a Jewish refugee from Austrian anti-Semitism
▪Lived in NYC 1908-1911, conducted at Metropolitan Opera & NY Philharmonic
▪Had rheumatic heart disease

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▪Mahler was diagnosed with strep endocarditis by Libman (BMJ 1986;293:1628-1631)
▪No treatments at the time
▪Died in Vienna 5-11-1918

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Benjamin Sacks 1896-1971

▪MD Johns Hopkins
▪Worked at Mt. Sinai in NY with Libman
▪Left medicine in 1950s to be a medical technical adviser to the movie industry
▪Worked with Cary Grant, Bing Crosby, and Barry Fitzgerald

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▪Interests turned to history and genealogy of the American West
▪The Sacks Collection of the American West is located at the Arizona Historical Foundation in the Hayden Library on the Tempe campus of Arizona State University.
ahfweb.org/download/Sacks…

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We'll finish with a recent case from @TJUHospital
▪Young South Asian woman seen on consult service
▪Central retinal artery occlusion
▪2 miscarriages
▪Anti phospholipid antibody syndrome
▪Libman-Sacks on TEE!

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Thanks for your attention!

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