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Cardiovascular Week 6 2016/17 > 5: Infective endocarditis and other cardiac infections > Flashcards

5: Infective endocarditis and other cardiac infections Flashcards

1
Q

Blood is normally ___.

A

sterile

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2
Q

What is the name given to the presence of bacteria in the bloodstream?

A

Bacteraemia / septicaemia

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3
Q

If septicaemia is left untreated, the patient can go into ___ ___ and die.

A

septic shock

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4
Q

Before an appropriate antimicrobial treatment is prescribed, you need to take __ __ to figure out what organism you need to target.

A

blood cultures

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5
Q

What is infective endocarditis?

A

Infection of the endothelium of the heart valves

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6
Q

Infective endocarditis causes ___ blood flow which promotes the growth of microbes into big lumps.

A

turbulent

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7
Q

Infective endocarditis can be either ___ or _-___.

A

acute , subacute

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8
Q

What are predisposing factors for infective endocarditis?

A

Heart valve abnormalities - calcification, sclerosis, congenital heart disease and rheumatic fever

Prosthetic heart valves

IV drug users

IV lines

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9
Q

___ and ___ are deposited on heart valves with areas of turbulent blood flow.

A

Platelets , fibrin

i.e a thrombus forms

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10
Q

What settles in fibrin/platelet thrombi in the heart valves?

A

Bacteria

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11
Q

Microbes released by ___ treatment can be involved in infective endocarditis.

A

dental

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12
Q

Infected “vegetations” are friable - what does this mean?

A

Unstable, likely to break off

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13
Q

Infected vegetations break off and lodge in __ ___, where they can cause abscess or haemorrhage.

A

capillary beds

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14
Q

Which side of the heart, and which valves, are more commonly affected by endocarditis?

A

Left side

(mitral, aortic valves)

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15
Q

What is the most common organism causing endocarditis?

A

Staphylococcus aureus

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16
Q

What are the four most common organisms which cause endocarditis?

A

Staphylococcus aureus

Streptococcus virdians

Entercoccus spp,

Staphylococcus epidermidis

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17
Q

What are some atypical organisms which cause endocarditis?

A

Bartonella

Coxiella burnetti (Q-fever)

Chlamydia

Legionella

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18
Q

What are the major Duke criteria for diagnosing endocarditis?

A

Two separate positive blood cultures for typical organisms (to prove it’s PERSISTENT)

Echocardiogram evidence of valve lesions

New valvular regurgitation

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19
Q

When diagnosing endocarditis, at a minimum, how many positive blood cultures do you need?

A

2

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20
Q

How do you obtain evidence of valvular lesions to diagnose endocarditis?

A

Echocardiogram

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21
Q

What kind of valve disease indicates endocarditis?

A

Regurgitation

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22
Q

Which two echos are done to diagnose endocarditis?

A

Transthoracic echo

then

Transoesophageal echo to make sure

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23
Q

What kind of microbe is Staph. aureus?

A

Gram +ve cocci

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24
Q

How do staphylococci appear?

A

Big round clumps

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25
Q

If you find Staph. epidermidis after doing a blood culture, chances are it is there as a result of…

A

contamination

i.e not responsible for the endocarditis - it might be tho

26
Q

In which case should the appearance of Staph. epidermidis be taken more seriously than normal?

A

If it is persistently appearing and the patient has a lot of prosthetic material

27
Q

Coagulase positive Staphylococcus are ___ ___.

A coagulase negative Staphylococcus is ___ ___.

A

Staph. aureus

Staph. epidermidis

28
Q

What new tool allows microbiologists to better identify organisms?

A

MALDI-TOF

29
Q

The most dangerous gram positive organism, causing high mortality endocarditis, is…

A

Staph. aureus

30
Q

How do patients present with acute endocarditis?

A

Sepsis

Cardiac failure

31
Q

What are the symptoms of subacute endocarditis?

A

Fever

Malaise

Weight loss

Fatigue

Breathlessness

32
Q

What are the signs of subacute endocarditis?

A

Fever

Cardiac murmurs

Finger clubbing

Splinter haemorrhages

Roth spots

Osler nodes

Janeway lesions

33
Q

Which group of microorganisms tend to cause subacute endocarditis?

A

Viridans group of Streptococci

34
Q

What is the difference between Osler’s nodes and Janeway lesions?

A

Osler’s nodes are painful (Osler = ouch)

Janeway lesions aren’t painful

35
Q

How many blood cultures should you take to confirm persistent bacteraemia?

A

3 sets

36
Q

Why are transthoracic echos easier to perform than transoesophageal echos?

A

No fasting required

Can be done at the bedside

37
Q

A typical echo finding of endocarditis is valve…

A

mobility - i.e it moves a ton, is loose

38
Q

People with ___ valves are more likely to get endocarditis.

A

prosthetic

39
Q

Rifampicin tends to be used when the bacterial volume has been reduced as bacteria tend to become ___ to it.

A

resistant

40
Q

People who inject ___ are more likely to develop endocarditis.

A

drugs

41
Q

Which kind of endocarditis tends to start on the right side of the heart?

A

Endocarditis in people who inject drugs

42
Q

Which microbe causes endocarditis in people who inject drugs?

A

Staphylococcus aureus

43
Q

What can occur as a result of right heart blood stasis in the endocarditis of PWID?

A

Pulmonary emboli

44
Q

How long are IV antibiotics given for infective endocarditis?

A

4-6 weeks

45
Q

The prognosis of endocarditis very much depends on other patient ___.

A

factors

46
Q

In general, prophylaxis for endocarditis gives (a great benefit / absolutely no benefit).

A

absolutely no benefit

Not done anymore.

47
Q

What kind of heart inflammation is more common in young people?

A

Myocarditis

48
Q

What are some symptoms of myocarditis?

A

Fever

Chest pain

Breathlessness

Palpitations

49
Q

What are some signs of myocarditis?

A

Arrythmia

Cardiac failure

50
Q

What kind of microbes tend to cause infective myocarditis?

A

Viruses

51
Q

Which three types of viruses are responsible for most myocarditis?

A

Enteroviruses (coxsackieviruses)

Adenoviruses

Influenza

52
Q

What is the treatment for viral myocarditis?

A

Rest

Analgesia

53
Q

Most viral myocarditis resolves normally.

However, if there is an autoimmune reaction, what kind of cardiomyopathy can result?

A

Dilated cardiomyopathy

which can cause sudden death due to heart failure.

54
Q

What is pericarditis?

A

Inflammation of the pericardium

55
Q

Which two inflammatory heart diseases tend to occur together?

A

Myocarditis and pericarditis

56
Q

What is the main symptom of pericarditis?

A

Chest pain

57
Q

Which viruses tend to cause pericarditis?

A

Viruses - coxsackieviruses, adenoviruses, influenza

58
Q

If pericarditis occurs as a result of ___, it is treated much more seriously.

A

tuberculosis

59
Q

What is the treatment for pericarditis?

A

Bed rest

Analgesia

60
Q

What surgical intervention is performed for severe endocarditis?

A

Valve replacement

Cardiovascular Week 6 2016/17 (6 decks)

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