Cardiovascular Infections Flashcards
Common pathogens of bacterial endocarditis
acute- s. aureus; subacute- strep viridans, strep pneumo; Fungal- candida, aspergillus
Pathogens of Native valves
- Strepto Viridans, 2. S. aureus
Pathogens of IV drug users
- S. aureus, 2. Gram -/Strepto
Pathogens of Prosthetic valves
Staphylococcus (early); Streptococcus (late)
Difference between subacute and acute bacterial endocarditis
Acute- normal valves, fulminant, high fever, acutely ill, RAPID DESTRUCTION of valve and resulting CHF (high mortality rate).——-Subacute- abnormal valves, indolent- weeks of sx before dx
Modified Duke Criteria
2 Major, 5 minor, 1 major and 3 minor needed to dx BE. Major- 2 positive blood test w/ typical pathogen, evidence in cardiac echo (vegitation, abscess, regurg, damage), Q fever————-Minor- heart disease or IV drug use, fever >33, vascular/immunologic phenomena, positive blood test or echo not in major criteria
Presentation of bacterial endocarditis
nonspecific symptoms for ~2 weeks after bacteremia, LOW GRADE FEVER and night sweats, myalgias and arthralgias, low back pain, MURMUR, splenomegaly
What are the most common findings in bacterial endocarditis?
Low grade fever and murmur
What valves are most affected?
MITRAL, then atrial. Tricuspid is seen in IV drug use
What are complications of bacterial endocarditis?
septic emboli, CHF and perivesicular abscess
Embolic Phenomena
most common in the conjunctiva. Splinter hemorrhages under nails, Osler nodes (painful red lesions on pads of fingers and toes), Janeway lesions (red macules, nontender), Roth spots (retinal hemorrhages w/clear center)
Testing and Dx of Endocarditis
ECHO - transthoracic, look for valvular damage, vegetation (if none do a transesophageal); POSITIVE BLOOD CULTURES IN 95% (do 3 in 24 hours), CXR is final option
Transesophageal vs transthoracic echo
TEE is more sensitive than TTE. TEE is always preferred for prosthetic
When do we use Endocarditis prophylaxis
recommended in some dental or respiratory procedures. (tonsillectomy, or if surgery breaks respiratory mucosa).
What do we use for endocarditis prophylaxis
amoxicillin or ampicillin if NPO
Tx for Endocarditis
with a cidal Abx.
Tx of Native Valve
vancomycin
Tx of prosthetic valve
vancomycin PLUS gentamicin PLUS rifampin; consider consultation
If S. Viridans how do we tx?
PCN G/Amp PLUS gentamicin
When is surgery appropriate for endocarditis?
have a low threshold for surgery, consult early
Indications for surgery in endocarditis
moderate/severe CHF, more than one systemic embolus, uncontrolled infection, resistant bacteria, abscess or leak
