Blonder - Infective Endocarditis

Question 1

What are some factors that contribute to infective endocarditis?

Answer 1

Indwelling IV catheters
Prosthetic valve replacements
Orthopedic hardware
Pacers/defibs
IV drug abuse

Question 2

What is the most common placement for pacemaker wires?

Answer 2

R ventricular lead crosses the tricuspid valve. Can cause infective endocarditis

Question 3

What is the most common cause of acute bacterial endocarditis?

Answer 3

Staph aureus

Question 4

What are you listening for when evaluating for endocarditis?

Answer 4

Aortic, mitral, and tricuspid regurgitation, maybe pulmonic regurgitation.

Question 5

Why are murmurs easier to hear on L side than R?

Answer 5

The resistance is higher on the L side, and the pressure gradients are larger, which makes the murmurs louder.

Question 6

How can you distinguish tricuspid from bicuspid (mitral) regurgitation on auscultation?

Answer 6

Have the pt take a deep breath; tricuspid regurgitation will get louder with inspiration, whereas bicuspid (mitral) regurgitation will not.

Question 7

Bacterial endocarditis FROM JANE

Answer 7

Fever
Roth Spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail-bed hemorrhage
Emboli

Question 8

What is needed to diagnose IE per the Duke Criteria?

Answer 8

2 major criteria
OR 1 major, 3 minor criteria
OR 5 minor criteria

Question 9

What are the Duke Major Criteria for IE?

Answer 9

Typical microorganism consistent with IE from 2 separate blood cultures
OR
Microorganisms consistent with IE from persistently positive blood cultures
OR
Evidence of endocardial involvement: either positive echo or new valvular regurgitation

Question 10

What are the typical microorganisms for endocarditis?

Answer 10

Staph aureus
Strep viridans
Strep gallolyticus (bovis)
Enterococci
HACEK group

Question 11

What are the HACEK group microorganisms?

Answer 11

Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella