Thread by @Ed_Alania

🔵Right-Sided Infected Endocarditis 2020: Challenges & Updates in Diagnosis and Treatment #CardioEd via @JAHA_AHA
✅Compared w/Left-Sided ⬇️information📚features & management
✅Right-Sided 5-10% of all IE cases
✅Link ⬆️ IV drugs use, intracardiac devices, CVC
Thread🧵(1/7)

(2/7) The modified 2015 duke criteria by @ESC_Journals difficult to apply in these 👥 because of lower sensitivity. Modifications proposed
✅local signs of infection
✅pulmonary embolism
@MediCasos @Drainternista @MrDoctorOficial @ZavalaGerard @AmbrizMau @IsaMathiasMD @cpgale3

(3/7)
✅Staph aureus most prevalent🦠60-90%
✅#echofirst TTE limited sens detecting veggie attached pacemaker leads. TEE 👍 areas close to or within sup vena cava (70-90% vs 20-30%)
✅Dont forget 🔍embryonic remnants
✅Help w/ 18-PET/TC or radiolabeled white blood cells SPECT

(4/7)
✅TV involved 90% right-sided IE related IVDU
✅Most common complications: Valv regurg, abscess & septic pulmonary embolism
👩🏼36yo SLE on dialysis. Sepsis + MRSA bacteremia🩸. Infective endovascular fibrin sheath veggie @DocStrom @AmitGoyalMD @AmitRPatelMD @tiffchenMD

(5/7)✅Invasive disease (abscess, cavities or pseudoaneurysms) rare right-sided IE (0.7%)
✅Invasive IE: aortic valve (65%), mitral valve (31%)
💡Requires high intracavitary pressure. RV (⬇️Pressure⬇️O2) @alberto_bouzas @Alberta_Yen @almasthela @j4rmando @CyntiaMachain @ArgaizR

(6/7)
✅IV antibiotics💉cornerstone
✅Indications for Surgical interventions
✅AngioVac system: percutaneous aspiration. Where risk TV surgery is prohibitive @Enmatld @PamelaRaRa @alexarias2010 @SamRRazaMD @RigolinVera @LuzCabral3 @ClaudiaAlmont17 @APisaryuk @Ana_Viana_T

(7/7) 👦🏼27yo homeless IE,MRSA. Antibiotics + vegetation debulking. Case via @JACCJournals @JGrapsa by @DonAdrianM @DrAmirKaki @DukeCardFellows #CardioEd #echofirst @linrsantamaria @GARCIAEDINSON95 @gonzaeperez @LeonCardio @CardioflashC @Cardiobro @cmcsousa @Fedeilardi @giodisal

📂 doi.org/10.1161/JAHA.1…
📂 doi.org/10.1016/j.jacc…
@Sarah_Moharem @saramoscatelli7 @sarahhudsonuk @victoria_vilata @MTLLluva @Giulia_Vinco @MaicolCortezS @kristelmedinamd @AndrewJSauer @OKiamanesh @RaynerHartleyMD @MikeMD2486 @DorianEncinas @JuanK_MT_ @cpachecoMD @RBP0612

@SolovevaAnzhela @DrAdrianNaranjo @thaiscoutinhoCV @drmonalidesai @hpatel824 @AndreasGevaert @cardionerds @DrGEMandoli @wendy_junes @CardiologyGirl @Ahmed43101178 @fazalabul @SABOURETCardio @CNCFCardio @guiselaflores @marisol_ascenci @VazyurVasquez @Serginho1409 @ShreyaTrivediMD