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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?

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
How can a diagnosis be made based on Dukes criteria?
If there is the presence of; 2 major 1 major + 3 minor 5 minor
26
What are the major factors in Dukes criteria for infective endocarditis?
+ve blood cultures | Endocardium involved§
27
What constitutes +ve blood cultures in Dukes criteria?
Typical organism present in 2 separate cultures, or persistently +ve cultures, e.g. 3 >12 hours apart
28
What constitutes the endocardium being involved in Dukes criteria?
+ve echo showing vegetation, abscesses, or valve dehiscence, or new valvular regurgitation
29
What are the minor factors in Dukes criteria for infective endocarditis?
``` Predisposition Fever >38 Emboli Immune phenomenon +ve blood culture not meeting major criteria ```
30
Give two examples of 'predisposition' to infective endocarditis
Cardiac lesion | IVDU
31
Give 3 examples of evidence of 'emboli' in infective endocarditis
Septic infarcts Splinter haemorrhages Janeway lesions
32
Give 4 examples of evidence of immune phenomenon in infective endocarditis
Glomerulonephritis Osler nodes Roth spots Rheumatoid factor
33
What antibiotics are used in the empirical management of acute severe infective endocarditis?
Fluclox and gent IV
34
What antibiotics are used in the empirical management of subacute infective endocarditis?
Benpen and gent IV
35
What antibiotics are used in the management of infective endocarditis caused by streps?
Benpen + gent IV
36
What antibiotics are used in the management of infective endocarditis caused by enterococci?
Amoxicillin and gent IV
37
What antibiotics are used in the management of infective endocarditis caused by staphs?
Fluclox, with or without rifampicin IV
38
What antibiotics are used in the management of infective endocarditis caused by fungi?
Flucytosine IV, with or without fluconazole PO
39
When should you consider surgery in infective endocarditis?
Heart failure Emboli Valve obstruction Prosthetic valve

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

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