[Infectious endocarditis in a drug addict].
OBJECTIVE
To compare two groups of patients with infective endocarditis, the drug addicts and non-drug addicts. We attempted to set particularities among the various aspects that involve the patient with endocarditis, due to the concurrent chronic use of cocaine intravenously.


METHODS
Twenty nine patients, group B, whose clinical diagnose was compatible with infective endocarditis, with risk factor of parenteral toxicomania by cocaine were treated at Institute "Dante Pazzanese de Cardiologia" and Hospital "Emilio Ribas" in São Paulo, from 1984 to 1990. The data obtained for etiological agents, previous cardiac pathology, affected heart structures, affected heart side and clinical-surgical evolutions of group B were compared to group A (193 patients), which was also composed of patients with endocarditis, without chronic endovenous use of cocaine antecedent. The data obtained were analysed comparatively according to the chi square with Yates correction.


RESULTS
Male gender (89.7%) was predominate in group B towards group A (57.0%); (p < 0.01). Previous cardiopathy, either congenital or acquired, as antecedent proning to endocarditis, was found in 89.1% of patients in group A, significantly higher than 17.2% of patients group B (p < 0.001). Staphylococcus aureus was the most frequent agent, which accounted for endocarditis of group B in 86.4% of the cases, significantly higher when compared to 23.9% of cases of group A (p < 0.01). Streptococcus viridans was the most frequent etiological agent for endocarditis of group A (44.8%), significantly higher than group B (4.5%), (p < 0.01). In concern to the affected structures, the tricuspid valve was most affected in group B (65.5%), significantly higher than group A (4.7%) p < 0.001. The mitral valve was significantly more affected in group A (45.1%) in comparison to group B (6.9%), (p < 0.05). In group A 82 patients (42.5%) required surgical treatment and this occurred in 3 patients of group b (10.3%), (p < 0.05). No significant statistical difference was found as for the general mortality (clinical and surgical) in both groups.


CONCLUSIONS
a) presence of previous cardiac disease was lower suggesting permanent contamination blood flow by pathologic agents, mainly of those found in the skin as S. aureus; b) right side of the heart is most frequently affected, specially the tricuspid valve even without previous damage.
Jorge
S do C
Sdo C
Instituto Dante Pazzanese de Cardiologia, São Paulo.
Abboud
C S
CS
Prado
P S
PS
Assef
J E
JE
Arnoni
A S
AS
Piegas
L S
LS
Sousa
J E
JE
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003042:Cocaine; D004697:Endocarditis, Bacterial / Q000209:etiology*; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000150:complications*; D013290:Streptococcal Infections / Q000150:complications; D015819:Substance Abuse, Intravenous / Q000150:complications*; D014261:Tricuspid Valve
D003042:Cocaine
Endocardite infecciosa em toxicômanos.