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# LIBMAN-SACK ENDOCARDITIS:

## OVERVIEW:
Libman-sack endocarditis is the one of the cardiac manifestations of  autoimmune systemic diseases most commonly Systemic Lupus Erythematosus. It may also be a finding in malignancy with the non-bacterial non-thrombotic involvement of the valves, most commonly the aortic and mitral valve. The most common complications include embolic phenomenon like cerebrovascular disease and infective endocarditis with valvular insufficeincy. The disease activity and titer of the antibodies in Systemic Lupus Erythematosus can be linked to Libman-sack Endocarditis.

## HISTORICAL PERSPECTIVES:
Libman and Sack in 1924, first coined this term for the sterile verrucous vegetations of the mitral and aortic valves in four patients in New York.

## PATHOPHYSIOLOGY:
Endothelial dysfunction and hypercoagulable state are the two most important events in the process of non-thrombotic non-bacterial endocarditis (NTBE), that lead to vegetation formation on the valves . In Systemic Lupus erythematosus and other autoimmune conditions, the formation of autoantibodies may damage he native valves creating a nidus for the formation of vegetation the vegetations can be small (less than 1mm), histopathologically consisting of fibrin, platelets thrombi, mono-nuclear cells and immune complexes.

## ETIOLOGY:
The major phenomenon involved in the etiology of Lib-man sack endocarditis are Systemic Lupus Erythematosus, Malignancy and Antiphospholipid syndrome. The prevalence of NTBE in malignancy is reported to be 1.25% as compared to 0.25% in general population, among which 2.7% is accounted for by the solid organ malignancies. About 33% prevalence is recorded in patients with either primary or secondary anti-phospholipid syndrome. A significant correlation of 6% to 11% exists between lupus findings and NTBE.

# Reference
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