Cardiac Infections

Question 1

What is infective endocarditis?

Answer 1

Infection of the endothelium of the heart valves

Question 2

Factors which predispose patients to endocarditis

Answer 2

Heart valve abnormality (CHD, post rheumatic fever)
Prosthetic heart valve
IV drug users
IV lines

Question 3

What is the pathogenesis of endocarditis?

Answer 3

Heart valve damage
Turbulent blood flow over roughened endothelium
Platelets/fibrin deposits
Bacteraemia
Organism settle in fibrin/platelet thrombi
(Usually left side)

Question 4

What are the main organisms that cause endocarditis?

Answer 4

Staph aureus
Viridans streo
Enterococcus
Staphepidermis

Question 5

Unusual organisms to cause endocarditis

Answer 5

“Atypical” organisms
Gram negatives
Fungi

Question 6

Acute presentation of endocarditis

Answer 6

Overwhelming sepsis

Cardiac failure

Question 7

Subacute symptoms of endocarditis

Answer 7

Fever 
Malaise 
Weight loss
Tiredness 
Breathlessness

Question 8

Subacute signs of endocarditis

Answer 8

Pyrexia
New or changing heart murmur 
Finger clubbing 
Splinter haemorrhages 
Splenomegaly 
Roth spots, Janeway lesions, Osler's nodes 
Microscopic haematuria

Question 9

Investigations for endocarditis

Answer 9

Blood culture

Echocardiogram

Question 10

What is the most common causative in prosthetic valve endocarditis which is infected at the time of insertion?

Answer 10

Staph aureus

Staph epidermidis

Question 11

What side is endocarditis more common in in IV drug users?

Answer 11

Right sided (tricuspid valve)

Question 12

What is the most common endocarditis causing organism in IV drug users?

Answer 12

Staph aureus

Question 13

what is the general native valve endocarditis treatment?

before blood culture

Answer 13

Amoxicillin

Gentamicin

Question 14

What is the general treatment for prosthetic valve endocarditis?
(before blood culture)

Answer 14

Vancomycin IV
Gentamicin IV
Rifampricin PO
(Usually valve replacement required)

Question 15

What is the first line treatment in drug user endocarditis?

before blood culture

Answer 15

Flucloxacillin IV

Question 16

What antibiotic is staph aureus sensitive to?

Answer 16

Flucloxacillin

Question 17

What antibiotics do you treat MRSA with?

Answer 17

Vancomycin IV

Rifampricin PO

Question 18

What antibiotics is strep viridans sensitive to?

Answer 18

Benzyl penicillin

Gentamicin IV

Question 19

What a tiptoes is enterococcus sensitive to?

Answer 19

Amoxicillin/ vancomycin IV

Gentamicin IV

Question 20

What antibiotics is staph epidermis sensitive to?

Answer 20

Vancomycin IV
Gentamicin IV
Rifampricin PO

Question 21

How long are IV antibiotics usually given for in endocarditis?

Answer 21

4-6 weeks

Question 22

What should be monitored during endocarditis treatment?

Answer 22

Cardiac function
Temperature
CRP

Question 23

What is myocarditis?

Answer 23

Inflammation of cardiac muscle

Question 24

Symptoms of myocarditis

Answer 24

Fever
Chest pain
Shortness of breath
Palpitations

Question 25

Signs of myocarditis

Answer 25

Arrhythmias

Cardiac failure

Question 26

What are the main causative organisms in myocarditis?

Answer 26

Enteroviruses
- Coxsackke A & B
But other viruses possible (e.g. Influenza)

Question 27

How is myocarditis diagnosed?

Answer 27

Viral PCR
Throat swab for influenza
Stool for Enteroviruses

Question 28

What is pericarditis?

Answer 28

Inflammation of pericardium

Question 29

Main feature of pericarditis

Answer 29

Chest pain relieved by sitting forward

Question 30

Causes of pericarditis

Answer 30

Mainly viraln
Can be caused by bacteria after cardiothoracic surgery
Rarely secondary spread from endocarditis or pneumonia

Question 31

Treatment of myocarditis and pericarditis

Answer 31

Supportive unless bacterial cause

Question 32

In terms of cardiology what can staph epidermis infect?

Answer 32

IV lines

Prosthetic heart valves