Consequences of valvular vegetations

An infected valvular vegetation may result in four consequences which together produce the clinical and pathological picture.

• bacteraemia and/or septicaemia:
  • this may cause fever, malaise, anorexia, weight loss, leucocytosis, anaemia, a raised ESR, a raised CRP, splenomegaly
    
    
• production of circulating immune complexes:
  • these may lead to splinter haemorrhages, Osler's nodes, Janeway lesions or glomerulonephritis
    
    
• local destruction of cardiac tissue:
  • this may lead to valvular incompetence, heart failure, cardiac conduction abnormalities, abscess formation, fistulas between right and left sides of the heart
  • disappearance of the first heart sound may signify aortic incompetence
    
    
• peripheral emboli:
  • these may cause strokes, splenic or renal infarction and mycotic aneurysms