Endocarditis Suspected for Rams’ Head Coach

[Guest guest]

Endocarditis Suspected for Rams' Head Coach

By , MedPage Today Staff Writer

Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University

of Pennsylvania School of Medicine.

October 07, 2005

http://www.medpagetoday.com/Cardiology/CHF/tb/1894

MedPage Today Action Points

Advise patients who ask that endocarditis most typically occurs in

patients with underlying valvular disease.

Advise patients that antibiotic treatment for endocarditis is

usually effective, but mortality varies according to the pathogen

involved and the circumstances of the condition.

Review

ST. LOUIS, Oct. 7 – Mike Martz, coach of the St. Louis Rams football

team, missed two practices this week because of what his doctors

think may be infective endocarditis. He may not be stalking the

sidelines when the Rams play the Seattle Seahawks on Sunday.

The team's physician, Pogue, M.D., is still conducting tests

on the 54-year-old Martz, who told reporters earlier this week that

he has been feeling ill for several weeks.

" There is some type of infection in my body that has gotten worse, "

Martz told reporters, but Dr. Pogue said later in a statement that

the diagnosis of endocarditis hasn't been confirmed yet.

Endocarditis affects between 10,000 and 15,000 people every year in

the U.S., said Blumenthal, M.D., director of the s Hopkins

Ciccarone Preventive Cardiology Center in Baltimore.

" Generally, people who get endocarditis have some sort of

abnormality in their heart valve to begin with, " Dr. Blumenthal

said. " The normal heart is much less likely to run into problems. "

The American Heart Association says that people at risk for the

disease include those with:

A prosthetic heart valve

A history of previous endocarditis

Valves damaged by conditions such as rheumatic fever

Congenital defects in the heart or valves

Or hypertrophic cardiomyopathy

But if it's diagnosed quickly and treated with antibiotics, Dr.

Blumenthal said, endocarditis is not considered unusually life-

threatening.

Endocarditis – formally an infection of the heart lining or valves –

often arises from bacteremia after surgery, whether major or minor.

Gum surgery, for instance, is often the spark that gives rise to the

condition. Other risk factors are intravenous drug use, permanent

central venous access lines, prior valve surgery, and weakened

valves.

Bacteria, such as Staphylococcus aureus, colonize the tissue and

form masses known as vegetations at the infection site. Under a

microscope, the pathogen can be seen embedded in a mesh of fibrin

and other materials.

In rare cases, endocarditis can be caused by a fungal infection.

Mortality varies depending on the pathogen involved, according to

the Merck Manual of Diagnosis and Therapy, ranging from less than

10% for Viridans streptococcus infection without major complications

to nearly 100% with Aspergillus infection after prosthetic valve

surgery.

The condition can be chronic, but is generally acute, Dr. Blumenthal

said.

The diagnosis of infective endocarditis is made on the basis of a

careful history and physical examination, blood culture and

laboratory results, an electrocardiogram (ECG), a chest radiograph,

and an echocardiogram. Criteria for diagnosis include positive blood

cultures in the absence of an obvious focus and the presence of

cardiac involvement as shown by echocardiogram or the development of

new valvular regurgitation. Testing for the condition – such as

Martz is undergoing – generally includes:

Baseline studies, such as complete blood count (CBC), electrolytes,

creatinine, blood urea nitrogen (BUN), glucose, and coagulation

panel.

Blood cultures, to try to identify a pathogen.

Transthoracic and transesophageal echocardiography, both highly

specific for valvular vegetations. Echocardiography is particularly

indicated if the cultures are negative, as would be the case if the

condition is caused by a fungal infection.

Martz said his main symptom is fatigue. " You feel really good and

then in the course of a couple hours you hit rock bottom,'' he said

in the statement.

Dr. Blumenthal said other possible symptoms include persistent fever

and chills and unexplained weight loss.

In the case of an otherwise healthy adult like Martz, Dr. Blumenthal

said, antibiotic treatment is usually effective. " I would be more

worried for people who have an immune suppression for one reason or

another, " he said. That would include patients with HIV, hepatitis

C, or cancer, he said.

" This is something that if you let it go, it could become a real

issue, " Martz said, noting that he did not plan to attend any of the

team's practices this week before Sunday's game with the Seattle

Seahawks.

Whether he will be on the sidelines for that game hasn't been

decided yet, Jay Zygmunt, the Rams' president of football operations

told the St. Louis Post-Dispatch earlier this week.

" That'll be addressed when we have to address it, " Zygmunt said.

Primary source: Circulation

Source reference:

Baddour LM et al. Infective Endocarditis: Diagnosis, Antimicrobial

Therapy, and Management of Complications. Circulation. 2005;

111:e394-e433

---------------------------------------------------------------------

-----------

[Guest guest]

>

> Endocarditis Suspected for Rams' Head Coach

>

> By , MedPage Today Staff Writer

> Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University

> of Pennsylvania School of Medicine.

> October 07, 2005

>

> http://www.medpagetoday.com/Cardiology/CHF/tb/1894

>

> MedPage Today Action Points

>

>

> Advise patients who ask that endocarditis most typically occurs in

> patients with underlying valvular disease.

>

>

> Advise patients that antibiotic treatment for endocarditis is

> usually effective, but mortality varies according to the pathogen

> involved and the circumstances of the condition.

>

>

> Review

> ST. LOUIS, Oct. 7 – Mike Martz, coach of the St. Louis Rams football

> team, missed two practices this week because of what his doctors

> think may be infective endocarditis. He may not be stalking the

> sidelines when the Rams play the Seattle Seahawks on Sunday.

>

>

> The team's physician, Pogue, M.D., is still conducting tests

> on the 54-year-old Martz, who told reporters earlier this week that

> he has been feeling ill for several weeks.

>

>

> " There is some type of infection in my body that has gotten worse, "

> Martz told reporters, but Dr. Pogue said later in a statement that

> the diagnosis of endocarditis hasn't been confirmed yet.

>

>

> Endocarditis affects between 10,000 and 15,000 people every year in

> the U.S., said Blumenthal, M.D., director of the s Hopkins

> Ciccarone Preventive Cardiology Center in Baltimore.

>

>

> " Generally, people who get endocarditis have some sort of

> abnormality in their heart valve to begin with, " Dr. Blumenthal

> said. " The normal heart is much less likely to run into problems. "

>

>

> The American Heart Association says that people at risk for the

> disease include those with:

>

>

> A prosthetic heart valve

>

> A history of previous endocarditis

>

> Valves damaged by conditions such as rheumatic fever

>

> Congenital defects in the heart or valves

>

> Or hypertrophic cardiomyopathy

> But if it's diagnosed quickly and treated with antibiotics, Dr.

> Blumenthal said, endocarditis is not considered unusually life-

> threatening.

>

> Endocarditis – formally an infection of the heart lining or valves –

> often arises from bacteremia after surgery, whether major or minor.

> Gum surgery, for instance, is often the spark that gives rise to the

> condition. Other risk factors are intravenous drug use, permanent

> central venous access lines, prior valve surgery, and weakened

> valves.

>

>

> Bacteria, such as Staphylococcus aureus, colonize the tissue and

> form masses known as vegetations at the infection site. Under a

> microscope, the pathogen can be seen embedded in a mesh of fibrin

> and other materials.

>

>

> In rare cases, endocarditis can be caused by a fungal infection.

>

>

> Mortality varies depending on the pathogen involved, according to

> the Merck Manual of Diagnosis and Therapy, ranging from less than

> 10% for Viridans streptococcus infection without major complications

> to nearly 100% with Aspergillus infection after prosthetic valve

> surgery.

>

>

> The condition can be chronic, but is generally acute, Dr. Blumenthal

> said.

>

>

> The diagnosis of infective endocarditis is made on the basis of a

> careful history and physical examination, blood culture and

> laboratory results, an electrocardiogram (ECG), a chest radiograph,

> and an echocardiogram. Criteria for diagnosis include positive blood

> cultures in the absence of an obvious focus and the presence of

> cardiac involvement as shown by echocardiogram or the development of

> new valvular regurgitation. Testing for the condition – such as

> Martz is undergoing – generally includes:

>

>

> Baseline studies, such as complete blood count (CBC), electrolytes,

> creatinine, blood urea nitrogen (BUN), glucose, and coagulation

> panel.

>

> Blood cultures, to try to identify a pathogen.

>

> Transthoracic and transesophageal echocardiography, both highly

> specific for valvular vegetations. Echocardiography is particularly

> indicated if the cultures are negative, as would be the case if the

> condition is caused by a fungal infection.

>

> Martz said his main symptom is fatigue. " You feel really good and

> then in the course of a couple hours you hit rock bottom,'' he said

> in the statement.

>

>

> Dr. Blumenthal said other possible symptoms include persistent fever

> and chills and unexplained weight loss.

>

>

> In the case of an otherwise healthy adult like Martz, Dr. Blumenthal

> said, antibiotic treatment is usually effective. " I would be more

> worried for people who have an immune suppression for one reason or

> another, " he said. That would include patients with HIV, hepatitis

> C, or cancer, he said.

>

>

> " This is something that if you let it go, it could become a real

> issue, " Martz said, noting that he did not plan to attend any of the

> team's practices this week before Sunday's game with the Seattle

> Seahawks.

>

>

> Whether he will be on the sidelines for that game hasn't been

> decided yet, Jay Zygmunt, the Rams' president of football operations

> told the St. Louis Post-Dispatch earlier this week.

>

>

> " That'll be addressed when we have to address it, " Zygmunt said.

>

>

>

>

> Primary source: Circulation

> Source reference:

> Baddour LM et al. Infective Endocarditis: Diagnosis, Antimicrobial

> Therapy, and Management of Complications. Circulation. 2005;

> 111:e394-e433

>

> ---------------------------------------------------------------------

> -----------

>