Marantic endocarditis

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 predilection:

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

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.