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(Chest. 1974;66:151-157.)
© 1974 American College of Chest Physicians

Heart Failure in Infective Endocarditis: Predisposing Factors, Course, and Treatment

John Mills M.D.1; Joe Utley M.D.1; and Joseph Abbott M.D.1

1 Division of Infectious Diseases, Medical Service, San Francisco General Hospital, and the Departments of Medicine and Surgery, University of California, San Francisco, Calif.

A review of 144 episodes of infective endocarditis showed heart failure (HF) developing in 55 percent of patients; two-thirds of these had severe HF. HF developed in over 80 percent of patients with aortic valvular insufficiency and/or enterococcal infection, but in less than 20 percent of patients with congenital heart disease or tricuspid valvular infection. Half of the patients with mitral valvular insufficiency developed HF. Nearly 95 percent of those who developed severe HF within six months had some degree of premonitory HF within one month following admission; HF seldom developed de novo after six months. In patients with severe HF and mitral and/or aortic insufficiency, valve replacement was clearly superior to medical therapy alone, even when active infection was present. Because of the high mortality at operation in patients with uncontrolled severe HF, surgical intervention is recommended at the first signs that mild HF is worsening, regardless of the length of prior antibiotic therapy.

Submitted on November 13, 1974
Accepted on February 7, 1974




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