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3: MED1 Y3 - Cardiovascular [2] > [20] Infective Endocarditis > Flashcards

[20] Infective Endocarditis Flashcards

1
Q

What happens in infective endocarditis?

A

Cardiac valves develop vegetations composed of bacteria and platelet-fibrin thrombus

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2
Q

What kind of endocarditis is produced in cardiac disease?

A

Sub-acute

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3
Q

What kind of endocarditis is produced in normal valves?

A

Acute

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4
Q

What are the risk factors for infective endocarditis?

A 
Prosthetic valves 
Degenerative valvulopathy
VSD, PDA, CoA
Rheumatic fever
Dental caries
Post-op wounds
IVDU
Immunocompromisation, including DM
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5
Q

What are the causes of culture +ve infective endocarditis?

A 
S. viridans
S. bovis
S. aureus
S. epidermidis
Enterococci
Pseudomonas
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6
Q

What are the causes of culture -ve infective endocarditis?

A 
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
Coxiella
Chlamydia
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7
Q

What are the non-infective causes of endocarditis?

A

SLE

Marantic

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8
Q

What are the categories of clinical features in infective endocarditis?

A

Septic
Cardiac
Embolic
Immune complex deposition

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9
Q

What are the septic clinical features of infective endocarditis?

A 
Fever
Rigors
Night sweats
Anaemia
Splenomegaly
Clubbing
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10
Q

What are the cardiac clinical features of infective endocarditis?

A

New/changing murmur
AV block
LVF

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11
Q

What are the embolic clinical features of infective endocarditis?

A

Abscesses in brain, heart, kidney, spleen, gut, and lung

Janeway lesions

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12
Q

What are the clinical features of infective endocarditis resulting from immune complex deposition?

A 
Microscopic haematuria 
Vasculitis 
Roth spots
Splinter haemorrhages
Osler's nodes
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13
Q

What causes haematuria in infective endocarditis?

A

Glomerulonephritis

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14
Q

What are Roth spots?

A

Boat-shaped retinal haemorrhages with a pale centre

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15
Q

What are Janeway lesions?

A

Painless palmar macules

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16
Q

What are Osler’s nodes?

A

Painful, purple papules on finger pulps

17
Q

What investigations are done in infective endocarditis?

A

Bloods
Urine
ECG
Echo

18
Q

What may be found on bloods in infective endocarditis?

A

Normochromic, normocytic anaemia
Increased ESR and CRP
Positive IgG

19
Q

What specific blood tests should be done in infective endocarditis?

A

3x cultures, >12 hours apart

Serology for unusual organisms

20
Q

What might be found on urine testing in infective endocarditis?

A

Microhaematuria

21
Q

What may be found on ECG in infective endocarditis?

A

AV block

22
Q

What can trans-thoracic echo detect in infective endocarditis?

A

Vegetations >2mm

23
Q

What is the advantage of trans-oesophageal echo over trans-thoracic echo in infective endocarditis?

A

It is more sensitive (90-100% compared to 50-60%)

24
Q

What is used for the diagnosis of infective endocarditis?

A

Dukes Criteria

25
Q

How can a diagnosis be made based on Dukes criteria?

A

If there is the presence of;
2 major
1 major + 3 minor
5 minor

26
Q

What are the major factors in Dukes criteria for infective endocarditis?

A

+ve blood cultures

Endocardium involved§

27
Q

What constitutes +ve blood cultures in Dukes criteria?

A

Typical organism present in 2 separate cultures, or persistently +ve cultures, e.g. 3 >12 hours apart

28
Q

What constitutes the endocardium being involved in Dukes criteria?

A

+ve echo showing vegetation, abscesses, or valve dehiscence, or new valvular regurgitation

29
Q

What are the minor factors in Dukes criteria for infective endocarditis?

A 
Predisposition 
Fever >38
Emboli
Immune phenomenon 
\+ve blood culture not meeting major criteria
30
Q

Give two examples of ‘predisposition’ to infective endocarditis

A

Cardiac lesion

IVDU

31
Q

Give 3 examples of evidence of ‘emboli’ in infective endocarditis

A

Septic infarcts
Splinter haemorrhages
Janeway lesions

32
Q

Give 4 examples of evidence of immune phenomenon in infective endocarditis

A

Glomerulonephritis
Osler nodes
Roth spots
Rheumatoid factor

33
Q

What antibiotics are used in the empirical management of acute severe infective endocarditis?

A

Fluclox and gent IV

34
Q

What antibiotics are used in the empirical management of subacute infective endocarditis?

A

Benpen and gent IV

35
Q

What antibiotics are used in the management of infective endocarditis caused by streps?

A

Benpen + gent IV

36
Q

What antibiotics are used in the management of infective endocarditis caused by enterococci?

A

Amoxicillin and gent IV

37
Q

What antibiotics are used in the management of infective endocarditis caused by staphs?

A

Fluclox, with or without rifampicin IV

38
Q

What antibiotics are used in the management of infective endocarditis caused by fungi?

A

Flucytosine IV, with or without fluconazole PO

39
Q

When should you consider surgery in infective endocarditis?

A

Heart failure
Emboli
Valve obstruction
Prosthetic valve

3: MED1 Y3 - Cardiovascular [2] (19 decks)

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