Cardiac Infections

Question 1

Classic clinical findings for infectious endocarditis (4):

Answer 1

• Roth spots
• Splinter hemorrhages
• Janeway lesions
• Osler nodes

Question 2

Infectious endocarditis - Duke criteria - positive blood culture (4):

Answer 2

• Two separate cultures + with organisms consistent with IE
• Microorganism consistent with IE from cultures more than 12 hours apart
• Microorganism consistent with IE from 3/4 cultures > 1 hour apart
• Single culture + for coxiella burnetti

Question 3

Infectious endocarditis - Duke criteria - Evidence of endocardial involvement (2):

Answer 3

• Positive echocardiogram

- NEW valvular regurgitation

Question 4

Infectious endocarditis - Duke criteria - minor criteria (5):

Answer 4

• Fever at least 100.4F
• Immunologic phenomena
• Positive blood culture not meeting major criteria
• Predisposing heart condition or hx of drug use
• Vascular phenomena

Question 5

Infectious endocarditis - Duke criteria - definitive endocarditis (3):

Answer 5

• Two major
• One major and 3 minor
• Five minor

Question 6

Infectious endocarditis - Duke criteria - possible endocarditis (2):

Answer 6

• One major and 1 or 2 minor

- Three minor

Question 7

Treatment for viridans streptococcus (4):

Answer 7

PCN = frequently bacteriostatic
- MIC < 0.1 mcg/ml: sensitive
- MIC 0.2 - 2 mcg/ml: mod resistant
     - Add aminoglycoside
MIC > 2 mcg/ml: aminoglycoside, longer period of tx

Question 8

HACEK organisms (5):

Answer 8

• Haemophilus aprophilus
• Actinobacillus actinomycetemcomitans
• Cardiobacterium hominis
• Eikenella corrodens
• Kingella kingae

Question 9

Haemophilus/Actinobacillus actinomycetemcomitans (4):

Answer 9

• Empyema an chest wall infection
• Pericarditis
• Endogenous flora of mouth
• Endocarditis

Question 10

Haemophilus/Actinobacillus actinomycetemcomitans treatment:

Answer 10

Third generation cephalosporins

- Ceftriaxone, cefotaxime etc.

Question 11

Cardiobacterium hominis (4):

Answer 11

• Endocarditis
• Non-motile, facultative anaerobic, small, pleomorphic gram negative rod
• Fermentative, indole and oxidase positive
• Found in respiratory tract of healthy humans

Question 12

Cardiobacterium hominis treatment (2):

Answer 12

Typically sensitive to PCNs

• Ceftriaxone 2g IV daily x 4 wks or
• Ampicillin with gentamicin

Question 13

Eikenella corrodens (2):

Answer 13

• Associated with human bite wounds

- Fist-fight injury

Question 14

Eikenella corrodens can cause (5):

Answer 14

• Endocarditis
• Sinusitis
• Pneumonia
• Brain abscesses
• Lung abscesses

Question 15

Kingella kingae (3):

Answer 15

• Small, gram-negative coccobacilli
• Human oropharynx
• Associated with “sterile”/aseptic arthritis in children

Question 16

Most common cause of myocarditis:

Answer 16

Coxsackie B virus

Question 17

Chagas disease - EKG findings:

Answer 17

Right BBB, left anterior hemiblock progressing to complete heart block

Question 18

Chagas disease -

echocardiogram findings:

Answer 18

Unique hypokinesis of posterior left ventricular wall and a relatively preserved septal motion

Question 19

Infectious myocarditis - lyme disease - treatment (2):

Answer 19

• If + blood titer and mild symptoms = doxycycline

- If + with 2nd/3rd degree AV block = hospitalize, IV ceftriaxone or PCN

Question 20

Infectious pericarditis clinical presentation (4):

Answer 20

• Acute chest pain
• Fever, chills and leukocytosis (think bacterial)
• Flue-like or GI symptoms (think viral)
• Friction rub on auscultation

Question 21

Infectious pericarditis EKG changes:

Answer 21

ST segment elevation:T-wave amplitude (in mm) in lead V6 exceeds 0.25

Question 22

Infectious pericarditis treatment:

Answer 22

NSAIDS and/or colchicine inpatient/outpatient

Question 23

Infectious pericarditis - most common cause of chronic effusion:

Answer 23

Tuberculosis