Cardio-Infective Endocarditis

Question 1

Most common cause of acute IE

Answer 1

Staph aureus

Usually fatal after 6 weeks of left untreated

Question 2

Most common cause of subacute IE

Answer 2

Viridans streptococci

ESP in pre damaged heart valves(stuctural heart defects, prosthetic valves)

Question 3

Most common cause of IE following dental procedures

Answer 3

Viridans streptococci

Question 4

Risk factors for IE (cardiac vs non cardiac)

Answer 4

Male over 60

Cardiac:
Acquired valvular disease for eg rheumatic heart disease and aortic stenosis)
Prosthetic heart valves
Congenital heart disease (vsd, bicuspid aortic valve)
Previous IE

Non cardiac: 
Poor dental status 
Dental procedures 
Intravascular devices 
Immunocompromised

Question 5

Clin features of IE

Answer 5

Fever chills tachycardia weight loss night sweats dyspnea pleuritic chest pain arthralgia myalgia

Cardiac: tricuspid valve regurg (holosystolic murmor heard best and left sternal border) - seen esp in patients who inject drugs, immunocompromised and patients with central venous catheters

Aortic valve regurg- early diastolic loudest and left 3rd and 4th intercostal

Mitral valve regurg- holosystolic best at apex

Symptoms of heart failure (lower limb edema and dyspnea due to valve insufficiency)

Arrhythmias

Extra cardiac: usually due to septic emboli
To abd organs for eg kidney causing acute renal injury
To brain causing septic emboli stroke- paresis and seizures
To pulm- signs of PE

Osler nodes splinter hemorrhage etc