Pathophysiology

Risk factors for the development of myocardial abscesses or mural endocarditis include chronic debilitating illness, immunosuppression, indwelling catheters, prolonged antibiotic therapy, and valvular endocarditis. The source of infection may be from hematogenous seeding or contiguous extension from valvular endocarditis. These two infections may coexist, or one may lead to the development of the other. In the case of mural endocarditis, bacteria may seed damaged endocardium or aneurysms in the ventricular wall. In the case of myocardial abscesses, multiple areas of the myocardium may be involved, but when valvular endocarditis is the source of bacterial seeding, the paravalvular areas are usually involved. The most common organisms in these nonvalvular infections of the heart are S. aureus, S. viridans, and other organisms associated with valvular endocarditis.

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