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SALMAN HARRISON'S > 123 - Infective Endocarditis > Flashcards

123 - Infective Endocarditis Flashcards

1
Q

What is the typical sign of endocarditis?

A

vegetation

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2
Q

Endocarditis usually involve the cardiac __ and __

A

valves

ventricular septal defects

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3
Q

Infective endarteritis= vegetation of the: 3

A

arteriovenous shunts
arterio - arterio shunts
aortic coarctation

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4
Q

Endocarditis may be __ or __

A

acute

sub-acute

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5
Q

The main pathogens causing endocarditis are:4

A

strep Viridans
staphylococci
HACEK
strep bovis (gallolyticus) - from the GI

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6
Q

HACEK= _

A 
Haemophilus  
Actinobacillus
Cardiobacterium 
Eikenella
Kingella
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7
Q

Health care NVE (__) is usually caused by: 3

A

native valve endocarditis
staph aureus
CoNS (Coagulase-negative staphylococci)
enterococci

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8
Q

Early PVE (__) is < __ days from surgery, late > _

A

prosthetic valve endocarditis
60
1 year

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9
Q

-% of endocarditis produce sterile cultures

A

5-15

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10
Q

NBTE=__, usually caused by __,__,__,__

A 
non bacterial thrombotic endocarditis
AR
MR
AS
VSD
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11
Q

__ and __ can cause sterile vegetation

A

SLE

APLA

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12
Q

Which pathogens lead to ABE? 3

A

pneumococci
S aureus
B hemolytic strep

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13
Q

Which pathogens lead to SBE? 4

A

HACEK
CoNS
enterococci
strep viridans

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14
Q

Which pathogens lead to indolent bacterial endocarditis? 2

A

C burnetii
bartonella
(Q fever)

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15
Q

In ABE patients will experience high fever >__

In SBE patients will experience high fever in __ cases

A

39.5

rare

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16
Q

Cardiac clinical signs of IE include: 5

A 
murmur 
CHF
cardiac abscess
AV block
MI
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17
Q

Non cardiac clinical signs of IE include: 5

A 
Osler's nodes
Janeway's lesions 
Roth's spots
musculoskeletal symptoms
arterial thrombus
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18
Q

CNS clinical signs of IE include: 3

A

embolic stroke
microabscess
seizures/encephalopathy

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19
Q

Renal clinical signs of IE include: 2

A

Hypocomplementemic glomerulonephritis

pelvic pain and hematuria due to embolic thrombi

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20
Q

IE in IVDU usually involve the __ valve alone, together with __. __ might exist or not. Other general symptoms include: 3

A 
tricuspid
fever
murmur
cough 
pleuritic pain
pneumothorax
21
Q

If IE in IVDU affect the __/__ valve as well, we might notice pain on the __ side, like in non-IVDU

A

aortic
mitral
left

22
Q

Which criteria is used to diagnose IE?

A

Duke’s criteria

23
Q

According to Duke’s criteria-
Definite IE- _ major / _ major + _ minor / _ minor
Possible IE- _ major + _ minor / _ minor

A

2 major / 1 major +3 minor / 5 minor

1 major + 1 minor / 3 minor

24
Q

We reject IE as a diagnosis if: 3

A

a different plausible diagnosis
symptoms resolve after 4 days of Abx
Unchanged biopsy after 4 days of treatment

25
Q

What are Duke’s major criteria? 2

A

blood culture (typical pathogen from two cultures, persistently positive blood culture)

endocardial involvement (new valvular regurgitation, positive echography, abscess)

26
Q

What are Duke’s minor criteria? 5

A

predisposition (prosthetic valve/previous IE/IVDU)
fever > 38
vascular phenomena
immunologic phenomena
macrobiotic evidence that does not meet major criterion

27
Q

Which non blood culture tests do you know?

A

TTE

TEE- more sensitive, if negative- repeat after 7-10 days

28
Q

If IE has low initial patient risk and low clinical suspicion- __

A

TTE

29
Q

If IE has high-moderate initial patient risk and high clinical suspicion or difficult condition- __

A

TEE

30
Q

What other more general examination suspected IE patients should go through? (3 groups of tests)

A

CBC/Cr/LF/CXR/ECG
blood sediments/RF/immune complex titer
PCI in elders before surgery

31
Q

When treating IE with Abx, the duration of treatment should be measured from the moment the cultures are __

A

negative

32
Q

What is the treatment for streptococci IE? 3

A

penicillin G/ceftriaxone/vancomycin (if allergy is present)

33
Q

What is the treatment for enterococci IE? 4

A

penicillin + gentamicin
ampicillin + gentamycin
vancomycin + gentamycin
ampicillin + ceftriaxone

34
Q

What is the treatment for staphylococci (CoNS/aureus) NVE IE?

A

oxacillin/nafcillin/cefazolin/vancomycin (if allergic to penicillin)

35
Q

What should be added to the treatment of PVE?

A

rifampin + gentamycin

36
Q

What is the empiric treatment for IVDU? what is the reason?

A

vancomycin + gentamycin/cefepime

to cover MRSA and G(-)

37
Q

What is the empiric treatment for subacute NVE? What should we add if the cultures are sterile and why?

A

vancomycin + rocephin (Ceftriaxone)/augmentin

doxycycline for bartonella

38
Q

What is the empiric treatment for subacute PVE < 1 year and >1 ? What should we add if the cultures are sterile?

A

vancomycin + gentamycin + cefepime
like sterile culture negative NVE ( vancomycin + rocephin / augmentin + doxycycline)
rifampin

39
Q

A stable IE patient w/o fever + negative culture + no clinical signs or positive echo :

A

treat as outpatient

40
Q

What are the 6 indications for treating IE with surgery?

A 
medium-severe CHF
perivalvular infection
uncontrolled infection
staph aureus IE
high risk for systemic emboli
CIED endocarditis
41
Q

When will you perform surgery for a patients with medium-severe CHF?

A

ASAP

42
Q

What is the gold standard to diagnose perivalvular infection?

A

TEE + color doppler

43
Q

In patients with CIED endocarditis, we should __ the device and __ it after - days of effective Abx treatment

A

remove
preimplant
10-14

44
Q

Which IE indications call for an emergency surgery (same day)? 4

A
  • valve dysfunction + pulmonary edema/cardiogenic shock
  • acute aortic regurgitation + preclosure of mitral valve
  • sinus/Valsalva abscess ruptured into right heart
  • rapture into pericardial sac
45
Q

Which IE indications call for an urgent surgery (1-2 days)? 6

A
  • valve obstruction by vegetation
  • unstable prosthesis
  • acute aortic/mitral regurgitation + HF (NYHA 3-4)
  • septal perforation
  • perivalvular extension of infection
  • lack of effective Abx therapy
46
Q

Which IE indications call for an elective surgery (preferred earlier as possible)? 6

A
  • progressive paravalvular prosthetic regurgitation
  • valve dysfunction + persisting infection (>7-10 days with Abx)
  • fungal endocarditis
47
Q

Post op- Abx should be given for the same amount of time it was given pre-op:

A

2 weeks before + 2 weeks after (4 weeks total)

48
Q

Mention 3 non cardiac complications

A

spleen abscess (drainage under imaging/splenectomy)
cerebral mycotic aneurism
non cerebral mycotic aneurism

49
Q

What are the indications for preventive predental treatment? 6

A
  • prosthetic valve
  • previous endocarditis
  • unrepaired cyanotic congenital heart disease
  • recently repaired cyanotic congenital heart disease (last 6 months)
  • partially repaired cyanotic congenital heart disease
  • post heart transplantation valvular disorder

SALMAN HARRISON'S (163 decks)

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