Cardiology: 8.5: Endocarditis

Question 1

What is endocarditis?

Answer 1

inflammation of the endocardium, esp. that which lines the surface of the cardiac valves

Question 2

What is nonbacterial thrombotic endocarditis?

Answer 2

sterile valve vegetations

Question 3

What is the hemolysis pattern of Strep. viridans?

Answer 3

alpha

Question 4

Strep. viridans can only infect which heart valves?

Answer 4

previously damaged valves

Question 5

Dx?

• sterile valve vegetations from SLE

Answer 5

• Libman-Sacks endocarditis
• “LSE in SLE”

Question 6

What lab findings are seen in endocarditis?

Answer 6

• positive blood cultures
• anemia of chronic disease (low MCV, low hemoglobin)
• high ferritin = TIPC low = serum Fe decreased

Question 7

What valves does Staph. aureus infect?

Answer 7

normal valves, esp the tricuspid

Question 8

What is the gram stain and morphology of Staph. epidermidis?

Answer 8

gram positive cocci in clusters

Question 9

Is Strep. viridans catalase positive or negative?

Answer 9

negative

Question 10

What is the hemolysis pattern of Strep. bovis?

Answer 10

gamma (no hemolysis)

Question 11

What kind of endocarditis do the HACEK organisms cause? Why?

Answer 11

• endocarditis w/ negative blood cultures
• they’re hard to grow

Question 12

What detects lesions on heart valves?

Answer 12

trans-esophageal echo (TEE)

Question 13

What is the endocarditis called when caused by Staph. aureus?

Answer 13

acute endocarditis

Question 14

You discover that your pt has endocarditis from Strep. bovis. What do you do next?

Answer 14

check for colorectal carcinoma

Question 15

What are Janeway lesions?

Answer 15

• erythematous, nontender lesions on the palms and soles
• assoc with endocarditis

Question 16

Why can Strep. viridans attach to damaged heart valves?

Answer 16

• the thrombotic vegetations that form trap these bacteria
• bc the bugs make dextrans

Question 17

What are the HACEK organisms?

Answer 17

• Hemophilus
• Actinobacillus
• Cardiobacterium
• Eikenella
• Kingella

Question 18

What are painful lesions on the fingers and toes assoc. with endocarditis called?

Answer 18

Osler nodes

Question 19

Where does nonbacterial thrombotic endocarditis arise? What does this cause?

Answer 19

• on the mitral valve along the lines of closure
• regurg

Question 20

What is Libman-Sacks endocarditis?

Answer 20

• sterile valve vegetations from SLE
• “LSE in SLE”

Question 21

What heart findings are associated with SLE?

Answer 21

• Libman-Sacks endocarditis:
  
  • vegetations on the surface and undersurface (both sides) of the mitral valve
  • mitral regurg
  • *** “LSE in SLE”

Question 22

Which bug commonly infects prosthetic heart valves?

Answer 22

Staph. epidermidis

Question 23

What is the endocarditis caused by Strep. viridans called?

Answer 23

subacute endocarditis

Question 24

What is the most common cause of endocarditis in IV drug abusers?

Answer 24

Staph. aureus

Question 25

Where is Strep. viridans a normal flora of the body?

Answer 25

in the mouth/oropharynx

Question 26

Dx? * vegetations on the surface and undersurface (both sides) of the mitral valve with mitral regurg

Answer 26

Libman-Sacks endocarditis

Question 27

Name a common way Strep. viridians enters the bloodstream.

Answer 27

dental work

Question 28

What is the gram stain and morphology of Strep. bovis?

Answer 28

gram positive cocci in chains

Question 29

How can Strep. bovis be differentiated from Group D strep/enterococci?

Answer 29

does not grow in 6.5% NaCl

Question 30

Is Viridans strep optochin sensitive or resisitant?

Answer 30

sensitive

Question 31

What are the s/s of endocarditis?

Answer 31

* fever * murmur (bc of vegetations on the valves) --\> : * Janeway lesions (erythematous, nontender lesions on the palms and soles) * Osler nodes (painful lesions on the fingers and toes) * splinter hemorrhages in the nailbeds * anemia of chronic disease

Question 32

What do thrombotic vegetations consist of? What do they attach to?

Answer 32

* platelets + fibrin * subendothelial collagen and tissue factor

Question 33

Where does Libman-Sacks endocarditis occur? What does this cause?

Answer 33

* on the surface and undersurface (both sides) of the mitral valve * mitral regurg

Question 34

Dx? * vegetations on the mitral valve along the lines of closure with mitral regurg

Answer 34

nonbacterial thrombotic endocarditis

Question 35

Is Staph. epidermidis catalase positive or negative?

Answer 35

positive

Question 36

What is the morphology of Strep. viridans?

Answer 36

gram positive cocci in chains

Question 37

What does Staph. aureus do to heart valves?

Answer 37

large vegetations destroy the valve --\> acute endocarditis

Question 38

Is Staph. epidermidis novobiocin sensitive or resistant?

Answer 38

sensitive

Question 39

What are Osler nodes?

Answer 39

painful lesions on the fingers and toes assoc. with endocarditis "Ouch Ouch Osler"

Question 40

What happens in endocarditis caused by Strep. viridans?

Answer 40

small vegetations form which do not destroy the valve

Question 41

What is a consequence of valve vegetations?

Answer 41

they can embolize (septic embolization)

Question 42

What is the most common overall causative organism of endocarditis?

Answer 42

Strep. viridans

Question 43

What causes nonbacterial thrombotic endocarditis?

Answer 43

* a hypercoagulable state * underlying adenocarcinoma

Question 44

Which bug commonly infects pts with underlying colorectal carcinoma?

Answer 44

Strep. bovis

Question 45

Is Staph. epidermidis coag positive or negative?

Answer 45

negative

Question 46

What usually causes endocarditis?

Answer 46

bacterial infection

Question 47

How can Strep. viridans be distinguished from S. pneumo?

Answer 47

Viridans is not encapsulated

Question 48

What are erythematous, nontender lesions on the palms and soles assoc. with endocarditis called?

Answer 48

Janeway lesions