Changes

==Introduction==

==Introduction==

*Pigs: [[Erysipelothrix_rhusiopathiae|''Erysipelothrix spp.'']]

*Pigs: [[Erysipelothrix_rhusiopathiae|''Erysipelothrix spp.'']]

*Sheep: [[:Category:Streptococcus species|''Streptococci'']]

*Sheep: [[:Category:Streptococcus species|''Streptococci'']]

==Pathophysiology==

==Pathophysiology==

===Vegetative Endocarditis===

===Vegetative Endocarditis===

[[Image:vegetative endocarditis.jpg|right|thumb|200px|<small><center>'''Vegetative endocarditis (dog)'''. Courtesy of T. Scase</center></small>]]

[[Image:vegetative endocarditis.jpg|right|thumb|200px|<small><center>'''Vegetative endocarditis (dog)'''. Courtesy of T. Scase</center></small>]]

It is predisposed by valvular damage as thrombi occur on the surface of the valves exposed to blood flow. Bacteremia is essential for the development of endocarditis. Once bacteria colonize the valvular endocardium, vegetative lesions composed of platelets and fibrin are formed on the valves. Progression to rupture of the ''chordae tendinae'' is possible, along with spread of the infection to the adjacent mural endocardium. Valves may become stenotic, incompetent or both. Death usually results from either embolisation of the vegetative material or congestive heart failure due to significant valvular damage.

It is predisposed by valvular damage as thrombi occur on the surface of the valves exposed to blood flow. Mechanical trauma can cause such damage, such as jet lesions from turbulent blood flow or endocardial injury from a catheter extending into the heart. Highly virulent bacteria or a heavy bacterial load increase the risk of cardiac infection, and normal valves can be invaded by virulent bacteria. Bacteremia is essential for the development of endocarditis. Diseases that impair immune responses or cause hypercoagulability or endothelial disruption are thought to increase the endocarditis risk. Once bacteria colonise the valvular endocardium, vegetative lesions composed of platelets and fibrin are formed on the valves. Progression to rupture of the ''chordae tendinae'' is possible, along with spread of the infection to the adjacent mural endocardium. Valves may become stenotic, incompetent or both. Congestive heart failure commonly results from valvular insufficiency and volume overload. Because the mitral and aortic valves are typically affected, pulmonary oedema is the usual manifestation. Death usually results from either embolisation of the vegetative material or congestive heart failure due to significant valvular damage. Metastatic infection of other body sites commonly occurs.  

===Ulcerative Endocarditis===

===Ulcerative Endocarditis===

==Signalment==

==Signalment==

Endocarditis is rare in dogs but males and large breeds (e.g. German Shepherds) are most affected. It is very rare in cats.

Endocarditis is rare in dogs but males and large breeds (e.g. German Shepherds) are most affected. Dogs with subaortic stenosis are more at risk of developing the disease. It is very rare in cats.

The disease mainly affects adult cattle and young pigs. In horses, males are more commonly affected than females.   

The disease mainly affects adult cattle and young pigs. In horses, males are more commonly affected than females.   

==Diagnosis==

==Diagnosis==

===Laboratory findings===

===Laboratory findings===

'''Blood profiles''': Not all cases will have altered blood changes. Possible changes include:

'''Blood profiles''': Not all cases will have altered blood changes. Possible changes include:

Radiography is often unremarkable. There may be evidence of cardiomegaly or congestive heart failure if valvular damage is chronic or severe. Evidence of a focus of infection such as discospondylitis may be visible.

Radiography is often unremarkable. There may be evidence of cardiomegaly or congestive heart failure if valvular damage is chronic or severe. Evidence of a focus of infection such as discospondylitis may be visible.

===Electrogcardiogram (ECG)===

===Electrocardiogram (ECG)===

ECG may be normal. Arrhythmias detectected are often ventricular in origin (e.g. ventricular premature complexes) and represent extension of the inflammatory focus to involve the myocardium. 3rd degree heart block may be present if the AV node is affected.

ECG may be normal. Arrhythmias detectected are often ventricular in origin (e.g. ventricular premature complexes) and represent extension of the inflammatory focus to involve the myocardium. 3rd degree heart block may be present if the AV node is affected.

==Treatment==

==Treatment==

Antibiotic treatment with either a broad spectrum antibiotic or an appropriate antibiotic based on culture and sensitivity results. Antibiotics should be administered intravenously for the first 5 days of therapy followed by a prolonged course (>4 weeks) of oral medication.  

Antibiotic treatment with either a broad spectrum antibiotic or an appropriate antibiotic based on culture and sensitivity results. Antibiotics should be administered intravenously for the first 5 days of therapy followed by a prolonged course (>4 weeks) of oral medication.  

<br>Common Protocols use [[Penicillins|Ampicillin]] in combination with a [[Fluoroquinolones|Fluoroquinolone]] such as Enrofloxacin.

<br>Common Protocols use [[Penicillins|Ampicillin]] in combination with a [[Fluoroquinolones|Fluoroquinolone]] such as Enrofloxacin or an aminoglycoside.

<br>Secondary problems such as septic shock, D.I.C., congestive heart failure and embolisation need to be managed.

<br>Secondary problems such as septic shock, D.I.C., congestive heart failure and embolisation need to be managed. Treatments commonly include diuretics or vasodilators to control the oedema, reduce valvular regurgitation and improve cardiac output.

==Prognosis==

==Prognosis==

Long term prognosis is guarded to poor. Possible complications include septic shock, disseminated intravascular coagulation, congestive heart failure and embolisation to other organs.

Long term prognosis is guarded to poor. Possible complications include septic shock, disseminated intravascular coagulation, congestive heart failure and embolisation to other organs.

[[File:CABI logo.jpg|left|90px]]

|literature search = [http://www.cabdirect.org/search.html?q=title:(%22endocarditis%22)&fq=sc:%22ve%22 Endocarditis publications]

 

 

[http://www.cabdirect.org/search.html?q=title:(%22endocarditis%22)&fq=sc:%22ve%22 Endocarditis publications]

[http://www.cabdirect.org/search.html?q=title:(%22endocarditis%22)+AND+od:(cattle)&fq=sc:%22ve%22 Endocarditis in cattle publications]

[http://www.cabdirect.org/search.html?q=title:(%22endocarditis%22)+AND+od:(cattle)&fq=sc:%22ve%22 Endocarditis in cattle publications]

[http://www.cabdirect.org/search.html?q=title:(%22endocarditis%22)+NOT+od:(cattle)&fq=sc:%22ve%22 Endocarditis in other veterinary species publications]

[http://www.cabdirect.org/search.html?q=title:(%22endocarditis%22)+NOT+od:(cattle)&fq=sc:%22ve%22 Endocarditis in other veterinary species publications]

==References==

==References==

* Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''' ''Merial''

Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''' ''Merial''

[[Category:Endocardial_Pathology]][[Category:Cardiovascular_System_-_Inflammatory_Pathology]][[Category:Cattle]][[Category:Pig]][[Category:Sheep]]

[[Category:Endocardial_Pathology]][[Category:Cardiovascular_System_-_Inflammatory_Pathology]][[Category:Cardiac Diseases - Cattle]][[Category:Cardiac Diseases - Pig]][[Category:Cardiovascular Diseases - Sheep]]

[[Category:Expert_Review]][[Category:Cardiovascular Pathology - Dog]]

[[Category:Expert_Review - Farm Animal]][[Category:Expert Review - Horse]][[Category:Cardiac Diseases - Dog]][[Category:Cardiac Diseases - Horse]]

[[Category:Cardiology Section]]