Cardiovascular Disorders this section includes Chapter 83. Cardiovascular Surgery and Percutaneous Interventional Techniques Chapter 90. Melvin Cheitlin Infection of the heart valves or mural endocardial myocardium, resulting in the formation of endocardial vegetations. Infective endocarditis has become more prevalent among the elderly. Prevalence has increased because the number of elderly persons and of persons with prosthetic valves has increased, hospital-acquired bacteremia has become more prevalent, and persons with valvular heart disease survive longer.
Infective endocarditis affects eight times as many elderly men as elderly women.
The underlying cardiac lesions that predispose the elderly to endocarditis tend to differ from those in younger patients. Calcification of the mitral or aortic annulus with insufficiency is more common among the elderly, whereas congenital heart defects are more common among younger persons. The increased incidence of atherosclerosis in the elderly may be a factor, because atheromatous deposits in valves can cause turbulence, resulting in endothelial damage and thrombus formation. Endocarditis involving congenital heart defects other than those of the bicuspid valve occur infrequently in the elderly. The resulting thrombus or vegetation usually develops in areas of jet impingement and increased turbulence and acts as a site for bacterial attachment.