Marantic endocarditis

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Marantic endocarditis, also known as non-bacterial thrombotic endocarditis (NBTE) is the deposition of small sterile vegetations on valve leaflets. Marantic vegetations are often associated with previous rheumatic fever. Other risk factors include: hypercoagulable states, mucin-producing adenocarcinomas, lupus and trauma (e.g., catheters).

The disease affects the valves with the following prediliction: Mitral > Aortic > Tricuspid > Pulmonary.

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 (eosinophilic) and platelets but, unlike bacterial etiologies, contain little evidence of PMNs, microorganisms or inflammation.

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.