Nonbacterial thrombotic endocarditis
| Nonbacterial thrombotic endocarditis | |
|---|---|
| Specialty | Cardiology  |
Non-bacterial thrombotic endocarditis (NBTE) is a form of endocarditis in which small sterile vegetations are deposited on the valve leaflets. Formerly known as marantic endocarditis, which comes from the Greek marantikos, meaning “wasting away.”[1] The term "marantic endocarditis" is still sometimes used to emphasize the association with a wasting state[2] such as cancer.[3]
Histopathology
Grossly, vegetations form along lines of valve closure and are generally symmetric with a smooth or verrucoid (warty) texture. Histologically, lesions are composed of fibrin[4] (eosinophilic) and platelets but, unlike bacterial etiologies, contain little evidence of PMNs, microorganisms or inflammation.
Risk factors
Marantic vegetations are often associated with previous rheumatic fever.
Other risk factors include:
- hypercoagulable states
- malignant cancers, especially mucin-producing adenocarcinomas (most commonly associated with pancreatic adenocarcinomas)
- systemic lupus erythematosus: Referred to as Libman-Sacks endocarditis
- trauma (e.g., catheters)
Valve predilection
The disease affects the valves with the following predilection: aortic valve > mitral valve > tricuspid valve > pulmonary valve [5]
Diagnosis
Due to the non-invasive nature of NBTE, clinical examination may or may not reveal a new murmur.
An embolic stroke may be the first feature to suggest the diagnosis of NBTE. An echocardiograph may be used to further assess for valvular lesions.
References
- ^ Neurological Sequelae of Infectious Endocarditis at eMedicine
- ^ "Noninfective Endocarditis: Endocarditis: Merck Manual Professional". Retrieved 2008-12-22.
- ^ "Definition: marantic endocarditis from Online Medical Dictionary". Retrieved 2008-12-22.
- ^ "nonbacterial thrombotic endocarditis" at Dorland's Medical Dictionary
- ^ Eiken PW, Edwards WD, Tazelaar HD, McBane RD, Zehr KJ (2001). "Surgical pathology of nonbacterial thrombotic endocarditis in 30 patients, 1985–2000". Mayo Clin. Proc. 76 (12): 1204–12. doi:10.4065/76.12.1204. PMID 11761501.