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Mitral valve prolapse (MVP) has emerged as a prominent, predisposing structural cardiac abnormality and in adults accounts for 7 to 30 per cent of NVE in cases not related to drug abuse or nosocomial infection. This increased risk of endocarditis is largely confined to patients with both prolapse and a mitral regurgitation murmur. Risk is also increased among men and patients older than 45 years. Valve redundancy and thickened leaflets (> 5mm) by echocardiography also identify a population at increased risk for IE.
Over the past decade, the conceptual understanding of heart failure has changed significantly. Several large clinical trials have demonstrated that non-pharmacological and pharmaco
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