Page 143 - Clinical Pearls in Cardiology

Heart Disease and Fever 131

Contd...
• Skin and conjunctival • High ESR
hemorrhages
• Splinter hemorrhages—linear • High C-reactive protein level
streaks at the nail bed of fingers
and toes (they do not extend to
the tip of the nail as in traumatic
etiology)
• Janeway lesions—nontender • Positive rheumatoid factor
reddish macular lesions over
palms and soles due to septic
emboli

6. Which are the lesions that are at high-risk for
developing endocarditis?
Infective endocarditis is an endovascular, microbial
infection of intracardiac structures (in contact with
blood), including infections of the large intrathoracic
vessels and intracardiac foreign bodies. Infective
endocarditis is more likely to result from frequent
exposure to random bacteremias associated with daily
activities than from bacteremia caused by a dental, GI
tract or GU tract procedure. The maintenance of optimal
oral health and hygiene may reduce the incidence of
bacteremia from daily activities. So this is much more
important than prophylactic antibiotics for a dental
procedure in order to reduce the risk of endocarditis.
The only conditions in which antibiotic prophylaxis
is indicated because of the high-risk for developing
endocarditis are the following:
• Prosthetic cardiac valve or prosthetic material used
for cardiac valve repair
• History of previous infective endocarditis