5: Infective endocarditis and other cardiac infections

Question 1

Blood is normally ___.

Answer 1

sterile

Question 2

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

Answer 2

Bacteraemia / septicaemia

Question 3

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

Answer 3

septic shock

Question 4

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

Answer 4

blood cultures

Question 5

What is infective endocarditis?

Answer 5

Infection of the endothelium of the heart valves

Question 6

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

Answer 6

turbulent

Question 7

Infective endocarditis can be either ___ or _-___.

Answer 7

acute , subacute

Question 8

What are predisposing factors for infective endocarditis?

Answer 8

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

Prosthetic heart valves

IV drug users

IV lines

Question 9

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

Answer 9

Platelets , fibrin

i.e a thrombus forms

Question 10

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

Answer 10

Bacteria

Question 11

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

Answer 11

dental

Question 12

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

Answer 12

Unstable, likely to break off

Question 13

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

Answer 13

capillary beds

Question 14

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

Answer 14

Left side

(mitral, aortic valves)

Question 15

What is the most common organism causing endocarditis?

Answer 15

Staphylococcus aureus

Question 16

What are the four most common organisms which cause endocarditis?

Answer 16

Staphylococcus aureus

Streptococcus virdians

Entercoccus spp,

Staphylococcus epidermidis

Question 17

What are some atypical organisms which cause endocarditis?

Answer 17

Bartonella

Coxiella burnetti (Q-fever)

Chlamydia

Legionella

Question 18

What are the major Duke criteria for diagnosing endocarditis?

Answer 18

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

Echocardiogram evidence of valve lesions

New valvular regurgitation

Question 19

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

Answer 19

2

Question 20

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

Answer 20

Echocardiogram

Question 21

What kind of valve disease indicates endocarditis?

Answer 21

Regurgitation

Question 22

Which two echos are done to diagnose endocarditis?

Answer 22

Transthoracic echo

then

Transoesophageal echo to make sure

Question 23

What kind of microbe is Staph. aureus?

Answer 23

Gram +ve cocci

Question 24

How do staphylococci appear?

Answer 24

Big round clumps

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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

Question 27

Coagulase **positive** *Staphylococcus* are ___ \_\_\_. A coagulase **negative** *Staphylococcus* is ___ \_\_\_.

Answer 27

***Staph. aureus*** ***Staph. epidermidis***

Question 28

What new tool allows microbiologists to better identify organisms?

Answer 28

**MALDI-TOF**

Question 29

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

Answer 29

***Staph. aureus***

Question 30

How do patients present with **acute endocarditis**?

Answer 30

**Sepsis** **Cardiac failure**

Question 31

What are the symptoms of **subacute endocarditis**?

Answer 31

**Fever** **Malaise** **Weight loss** **Fatigue** **Breathlessness**

Question 32

What are the signs of subacute endocarditis?

Answer 32

**Fever** **Cardiac murmurs** **Finger clubbing** **Splinter haemorrhages** **Roth spots** **Osler nodes** **Janeway lesions**

Question 33

Which group of microorganisms tend to cause **subacute endocarditis**?

Answer 33

**Viridans group of *Streptococci***

Question 34

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

Answer 34

**Osler's nodes are painful _(Osler = ouch)_** **Janeway lesions aren't painful**

Question 35

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

Answer 35

**3 sets**

Question 36

Why are transthoracic echos easier to perform than transoesophageal echos?

Answer 36

**No fasting required** **Can be done at the bedside**

Question 37

A typical echo finding of endocarditis is valve...

Answer 37

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

Question 38

People with ___ valves are more likely to get endocarditis.

Answer 38

**prosthetic**

Question 39

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

Answer 39

**resistant**

Question 40

People who inject ___ are more likely to develop endocarditis.

Answer 40

**drugs**

Question 41

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

Answer 41

**Endocarditis in people who inject drugs**

Question 42

Which microbe causes endocarditis in people who inject drugs?

Answer 42

***Staphylococcus aureus***

Question 43

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

Answer 43

**Pulmonary emboli**

Question 44

How long are IV antibiotics given for infective endocarditis?

Answer 44

**4-6 weeks**

Question 45

The prognosis of endocarditis very much depends on other patient \_\_\_.

Answer 45

**factors**

Question 46

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

Answer 46

**absolutely no benefit** **Not done anymore.**

Question 47

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

Answer 47

**Myocarditis**

Question 48

What are some symptoms of **myocarditis**?

Answer 48

**Fever** **Chest pain** **Breathlessness** **Palpitations**

Question 49

What are some signs of **myocarditis**?

Answer 49

**Arrythmia** **Cardiac failure**

Question 50

What kind of microbes tend to cause **infective myocarditis?**

Answer 50

**Viruses**

Question 51

Which three types of viruses are responsible for most myocarditis?

Answer 51

Enteroviruses (coxsackieviruses) Adenoviruses Influenza

Question 52

What is the treatment for viral myocarditis?

Answer 52

**Rest** **Analgesia**

Question 53

Most viral myocarditis resolves normally. However, if there is an autoimmune reaction, what kind of cardiomyopathy can result?

Answer 53

**Dilated cardiomyopathy** which can cause sudden death due to heart failure.

Question 54

**What is pericarditis?**

Answer 54

**Inflammation of the pericardium**

Question 55

Which two inflammatory heart diseases tend to occur together?

Answer 55

**Myocarditis** and **pericarditis**

Question 56

What is the main symptom of pericarditis?

Answer 56

**Chest pain**

Question 57

Which viruses tend to cause pericarditis?

Answer 57

**Viruses** - coxsackieviruses, adenoviruses, influenza

Question 58

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

Answer 58

**tuberculosis**

Question 59

What is the treatment for pericarditis?

Answer 59

**Bed rest** **Analgesia**

Question 60

What surgical intervention is performed for severe endocarditis?

Answer 60

**Valve replacement**