Libman E, Sacks B. A hitherto undescribed form of valvular and mural endocarditis. Arch Intern Med ; Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med ;
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NCBI Bookshelf. Abdisamad M. Ibrahim ; Momin S. Authors Abdisamad M. Ibrahim 1 ; Momin S. Siddique 2. It is a term which is used for sterile vegetations on the cardiac valves. The first time this form of endocarditis was described was in by Emanuel Libman and Benjamin Sacks. It is also associated with increased mortality. The initial development of Libman-Sacks endocarditis is thought to be an endothelial injury in the setting of a hypercoagulable state.
This causes deposition of platelet thrombi and inflammatory molecules in the cardiac valves. In one study, the rate of LS endocarditis was higher in patients with underlying malignancy compared to the general population on autopsy 1.
They can dislodge and cause devastating embolic infarctions. In histopathology, LS endocarditis is associated with leaflet thickening. The vegetations can involve the entire surface of the leaflets, and appear in coalescent or clusters.
They also have a granular or verrucous appearance. The most common manifestations are secondary to embolism. Patient with underlying SLE may show manifestations of the underlying disease such as malar rash, pleuritis, pericarditis, and nephrotic syndrome. A hypercoagulable workup should also be obtained in each case suspected of LS endocarditis including lupus anticoagulant and antiphospholipid antibodies. However, the primary evaluation for LSE is by echocardiography. Trans-esophageal echocardiography has greater sensitivity and specificity than trans-thoracic echocardiography.
Irregular borders, heterogeneous echo density, and an absence of independent motion characterize the masses i. The masses are usually small and sessile, but they can be as large as 10 mm. The basal and mid portion of the mitral and aortic valves are involved most commonly. Diffuse or focal leaflet thickening of the mitral and aortic valves can be observed.
The involved valves may exhibit regurgitation. Coexistent cardiac complications of systemic lupus erythematosus may include pericardial effusion or thickening. The treatment for patients with LS endocarditis is not well established, partially due to the scarcity of information on the natural history of the disease in untreated patients.
Anticoagulation should be considered as secondary prevention for thromboembolic phenomena in patients who have had a thromboembolic event. In cases of significant valvular dysfunction, surgery should be performed according to established guidelines for valvular heart disease. Laboratory studies should include a complete blood count, complete metabolic panel, and blood cultures to exclude infective endocarditis. The prognosis of LS endocarditis has not been fully studied and there continues to be a need for further studies to better define prognosis.
From clinical observations, the prognosis of LS is considered poor. Patients may develop recurrent thromboembolic events, cognitive disability, and death. Libman-Sacks endocarditis should be considered in patients with underlying malignancy, systemic lupus erythematosus, and antiphospholipid antibody syndrome, who present with a thromboembolic phenomenon.
Prognosis is poor as patients usually have recurrent thromboembolic events, cognitive disability, and death. LS endocarditis is not common but when it presents it is often associated with high morbidity and mortality. The healthcare team including the pharmacists and nurses should be aware that the vegetations can embolize not only to the brain but also the extremities and intestine. If this is not recognized, then it can result in ischemica and necrosis of the organ involved.
Serial echos are required to follow the vegetations. The treatment for LS endocarditis is not well established but anticoagulation is recommended. The outcomes depend on the age of patient, presence of malignancy and other comorbidity.
To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet].
Search term. Libman Sacks Endocarditis Abdisamad M. Author Information Authors Abdisamad M. Histopathology In histopathology, LS endocarditis is associated with leaflet thickening. History and Physical Patients with Libman-Sacks endocarditis are usually asymptomatic. Prognosis The prognosis of LS endocarditis has not been fully studied and there continues to be a need for further studies to better define prognosis.
Pearls and Other Issues Libman-Sacks endocarditis should be considered in patients with underlying malignancy, systemic lupus erythematosus, and antiphospholipid antibody syndrome, who present with a thromboembolic phenomenon. Enhancing Healthcare Team Outcomes LS endocarditis is not common but when it presents it is often associated with high morbidity and mortality. Questions To access free multiple choice questions on this topic, click here. References 1. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution.
J Am Soc Echocardiogr. Non-bacterial thrombotic endocarditis: clinicopathologic correlations. Heart J. Non-bacterial thrombotic endocarditis in cancer patients. Acta Cardiol. Libman-Sacks endocarditis and embolic cerebrovascular disease.
An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus. Libman Sacks Endocarditis. In: StatPearls [Internet].
In this Page. Related information. Similar articles in PubMed. Cardiol Res. Epub May 3. Epub Mar Review Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis: a report of four cases and a systematic review of the literature.
The Portuguese Journal of Cardiology, the official journal of the Portuguese Society of Cardiology, was founded in with the aim of keeping Portuguese cardiologists informed through the publication of scientific articles on areas such as arrhythmology and electrophysiology, cardiovascular surgery, intensive care, coronary artery disease, cardiovascular imaging, hypertension, heart failure and cardiovascular prevention. The Journal is a monthly publication with high standards of quality in terms of scientific content and production. Since it has been published in English as well as Portuguese, which has widened its readership abroad. It is distributed to all members of the Portuguese Societies of Cardiology, Internal Medicine, Pneumology and Cardiothoracic Surgery, as well as to leading non-Portuguese cardiologists and to virtually all cardiology societies worldwide. It has been referred in Medline since The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published.
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