15- Endocarditis

Question 1

pathological hallmark of infective endocarditis is

Answer 1

vegetation (microorganisms of one species, fibrin, platelets) on heart valves (more common on left side and on free margins of incompetent valves)

Question 2

right sided infective endocarditis occurs more often in which pts

Answer 2

pts who are IV drug users, have pacemakers, long term indwelling vascular access devices - hemodialysis pts

Question 3

risk factors for infective endocarditis

Answer 3

age>60
male
injection drug use
dental infection
structural heart disease
valvular disease
congenital heart disease
prosthetic heart valves
history of infective endocarditis
intravascular device
chronic hemodialysis

Question 4

what are the 3 most common causes of infective endocarditis

Answer 4

staphylococci (more HA IE)
streptococci (elderly- more CA-IE)
enterococci

Question 5

symptoms of infective endocarditis

Answer 5

fever, B symptoms, cardiac murmur, petechiae, septic emboli

Question 6

uncommon findings of infective endocarditis

Answer 6

Splinter hemorrhage
janeway lesions (non tender erythematous macules on palms and soles)
osler nodes (tender subcutaneous violaceous nodules on pads of fingers and toes- can occur on thenar and hypothenar eminance)
roth spots (exudative, edematous hemorrhagic lesions of the retina with pale centers)

Question 7

lab findings of infective endocarditis

Answer 7

elevated inflammation markers, anemia

Question 8

duke criteria for diagnosis of infective endocarditis

Answer 8

?

multiple blood cultures

Question 9

blood culture negative infective endocarditis

Answer 9

is endocarditis with no etiology following 3 independant blood samples. negative culture after 7 days
(HACEK grow in 5 days with BACTEC system)

Question 10

first line investigation for infective endocarditis

Answer 10

trans thoracic echocardiography (note that transesophageal is also often needed cuz its more sensitive)

Question 11

define empiric antibiotic tx

Answer 11

the initiation of antibiotics before identifying the infecting organism and its antibiotic susceptibility

Question 12

bactericidal antibiotic duration for IE

Answer 12

2-6 weeks for IE on a native valve
at least 6 weeks for IE on prosthetic valve
-If surgery is performed first, then take a culture to decide duration:
- Negative culture uses 2-6 weeks tx
- positive culture means start a new tx regimen

Question 13

tx for infective endocarditis

Answer 13

ampicillin, oxacillin, gentamicin

Question 14

when to perform surgery for IE

Answer 14

cardiac failure, uncontrolled infection, prevention of embolisms

Question 15

T/F Rheumatic heart disease and injection drug use are predisposing factors for infective endocarditis

Answer 15

T

Question 16

Congenital heart conditions that are RF for infective endocarditis

Answer 16

aortic stenosis
pulmonary stenosis
bicuspid aortic valve
VSD
PDA (patent ductus arteriosus)
coarctation of aorta
tetralogy of fallot

Question 17

Complications of infective endocarditis

Answer 17

• Neurological (15-30%)
• Spondilodiscitis (2-8%)
• Renal failure
• Speen (embolic foci)