Libman–Sacks endocarditis

Libman-Sacks concept boundary

Record the source's intended meaning and its relationship to the broader nonbacterial thrombotic endocarditis category.

1. Does the diagnosing source use Libman-Sacks specifically for autoimmune-associated lesions or as a broader synonym? definition
2. What evidence distinguishes this attribution from malignancy-associated or otherwise unexplained nonbacterial thrombotic endocarditis? boundary

Attribution evidence and version

Keep the diagnostic assertion distinct from the condition, its supporting observations, and the care encounter.

1. Who attributed the lesions to Libman-Sacks endocarditis, when, and using which imaging, clinical, or pathological evidence? provenance
2. If diagnostic criteria or a terminology code are recorded, what issuing body, edition, jurisdiction, and mapping source apply? provenance
3. Is the assertion suspected, clinically supported, tissue-supported, disputed, or excluded, and what uncertainty remains? definition

Vegetation topography and morphology

Record valve, leaflet surface, attachment, shape, mobility, and dimensions as observations rather than diagnostic proof.

1. Which valve, leaflet or cusp, and surface carry each lesion, and does it extend across the leaflet or coaptation region? measurement
2. What dimensions, attachment breadth, mobility, and echogenicity were reported for each lesion? measurement
3. What distinguishes the observed mass from isolated thickening, a strand, a tumour, or an artifact? boundary

Examination detection confidence

TEE detected lesions more effectively than TTE in a comparative SLE study; an absent finding must therefore retain its examination context. [Comparative study](https://pubmed.ncbi.nlm.nih.gov/18085739/)

1. Was the observation obtained using TTE, two-dimensional TEE, three-dimensional TEE, or tissue examination, and on what date? provenance
2. Which image-quality or sampling limitations constrain interpretation of an absent or equivocal lesion? measurement
3. Would additional imaging or review of existing tissue resolve a specific uncertainty sufficiently to justify clinician consideration? action

Lupus and antiphospholipid evidence

Record associated diagnoses, antibody evidence, and their timing without converting an isolated antibody result into an antiphospholipid syndrome diagnosis.

1. Is systemic lupus erythematosus or antiphospholipid syndrome independently established, suspected, or absent? boundary
2. Which dated disease-activity assessments and antiphospholipid antibody results were available when the valve lesions were assessed? provenance

Infection evidence and residual uncertainty

Represent the evidence used to judge infection unlikely or supported rather than inferring sterility solely from a negative culture.

1. What blood cultures and other indicated microbiological investigations were obtained, and did antibiotic exposure precede sampling? provenance
2. What clinical, imaging, or tissue evidence supports infection, argues against it, or leaves culture-negative infection unresolved? boundary
3. Which new findings would trigger prompt reassessment for concurrent or alternative infective endocarditis? action

Valve dysfunction attribution

Record regurgitation or stenosis severity, supporting measurements, and competing causes of dysfunction.

1. What regurgitation or stenosis grade and quantitative measurements accompany each affected valve? measurement
2. How strongly are symptoms or cardiac functional changes attributed to these lesions rather than another cardiac condition? boundary

Event-to-valve attribution

An SLE study associated Libman-Sacks vegetations with cerebrovascular disease; individual event attribution still requires assessment of competing causes. [Embolic cerebrovascular study](https://pmc.ncbi.nlm.nih.gov/articles/PMC3941465/)

1. Which suspected or established embolic events occurred, in what territories, and when relative to lesion detection? provenance
2. What evidence supports a valvular embolic source rather than antiphospholipid-related in situ thrombosis or another source? boundary
3. Do newly reported neurological or systemic ischaemic symptoms require urgent clinical assessment? action

Lesion evolution and residual damage

Track vegetation visibility and valve function separately, retaining uncertainty from changes in modality or image quality.

1. Are the same anatomical lesions being compared using sufficiently comparable imaging techniques and measurement methods? measurement
2. Have vegetation burden, valve dysfunction, and embolic events changed in the same or different directions? measurement
3. Does a no-longer-visualised lesion represent convincing regression, limited detection, or an unresolved change? boundary

Intervention rationale and follow-up

Link autoimmune treatment, antithrombotic treatment, valve intervention, and surveillance decisions to the specific problem they address.

1. Which documented indication supports each treatment decision: autoimmune activity, an embolic event, independently established antiphospholipid syndrome, or valve dysfunction? action
2. Which patient-specific constraints and unresolved infection questions materially affect the proposed intervention? action
3. What clinician-defined follow-up interval, outcome measures, and escalation triggers apply, and what evidence supports them? provenance

Check these first

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these check these first hold for the sense of Libman-Sacks endocarditis this model covers, and on what evidence? provenance

Identifiers and schemes

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these identifiers and schemes hold for the sense of Libman-Sacks endocarditis this model covers, and on what evidence? provenance

Real-world use

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these real-world use hold for the sense of Libman-Sacks endocarditis this model covers, and on what evidence? provenance

Failure modes and hazards

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these failure modes and hazards hold for the sense of Libman-Sacks endocarditis this model covers, and on what evidence? provenance

Regional variation

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these regional variation hold for the sense of Libman-Sacks endocarditis this model covers, and on what evidence? provenance

Neighbouring kinds and how to tell them apart

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these neighbouring kinds and how to tell them apart hold for the sense of Libman-Sacks endocarditis this model covers, and on what evidence? provenance