Nonbacterial thrombotic endocarditis

Marantic endocarditis, also known as non-bacterial thrombotic endocarditis (NBTE), is the deposition of small sterile vegetations on valve leaflets.

The previous term for nonbacterial thrombotic endocarditis (NBTE) was marantic endocarditis, from the Greek marantikos, meaning “wasting away.”^[1]

The term "Marantic endocarditis" is still sometimes used to emphasize the association with a wasting state^[2] such as cancer.^[3]

Risk factors

Marantic vegetations are often associated with previous rheumatic fever.

Other risk factors include:

• hypercoagulable states,
• mucin-producing adenocarcinomas,
• lupus and
• trauma (e.g., catheters).

Valve predilection

The disease affects the valves with the following predilection:

mitral valve > aortic valve > tricuspid valve > pulmonary valve.

Presentation

Grossly, vegetations form along lines of valve closure and are generally symmetric with a smooth or verrucoid (warty) texture. Histologically, lesions are composed of fibrin^[4] (eosinophilic) and platelets but, unlike bacterial etiologies, contain little evidence of PMNs, microorganisms or inflammation.

Diagnosis

Due to the non-invasive nature of NBTE, clinical examination may or may not reveal a new murmur.

It is imperative to take the blood pressure in both arms.

References

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