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Cardiology Exam IV > Clinical : Infective Endocarditis > Flashcards

Clinical : Infective Endocarditis Flashcards

1
Q

Infective Endocarditis

A

Infection of the endocardium (including the cardiac valves)

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2
Q

Classification of Infective Endocarditis: Clinical Course

A

Acute: Previously healthy valve, fast progression
Subacute: Unhealthy valves, slower less insidious progression

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3
Q

Classification of Infective Endocarditis: Host Substrate

A

Native Valve Endocarditis
Prosthetic Valve endocarditis
Intravenous Drug use induced endocarditis

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4
Q

Epidemiology

A 
2/100,000
Predispositions:
   Men more susceptible than women
   Older patients more likely to get IE
   PROSTHETIC VALVES !!! (Very Likely)
   Congenital Heart Disease
   PREVIOUS IE
   IV Drus use
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5
Q

Overall, what is the most common bacterial pathogen that causes IE ?

A

S. aureus

2nd would be Viridans Streptococcus.

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6
Q

Most common bacterial pathogen in EARLY PVE ? (Before 60 days)

A

S. epidermidis (CoNS with S. ludegnesis)

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7
Q

Most common bacterial pathogen in LATE PVE ? (After 60 days)

A

Viridans streptoccocus

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8
Q

Most common bacterial pathogen in IVDU Endocarditis ?

A

S. aureus

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9
Q

In IVDU Endocarditis, what side of the heart is preferentially affected ? Is it acute or subacute ?

A

Right sided heart, damage to the Tricuspid Valve

Acute: The valves were healthy previous to inoculation via IV drug use (most common pathogen is S. aureus)

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10
Q

Due to the the involvement of the right heart, what are patients with IVDU Endocarditis prone to ?

A

Pulmonary emboli !

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11
Q

What is often absent from IVDU Endocarditis that is seen in other classifications of the disease ?

A

THe peripheral stigmata such as splinter hemorrhages

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12
Q

Non-Thrombotic Endocarditis

A

Endocardial injury followed by thrombus of fibrin and platelets

This condition can predispose a person to getting IE since bacteria tend to bind to CT molecules of the thrombus.

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13
Q

What are the 4 conditions necessary for IE to occur ? (Except in IVDU Endocarditis)

A
  1. Endocardial damage
  2. Thrombus formation
  3. Bacterial entry into the blood stream
  4. Bacterial adherence to the thrombus/injured surface
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14
Q

Most sensitive symptom for Dx of IE ?

Most reliable ?

A

Fever

Murmur

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15
Q

List of Symptoms associated with IE

A 
Fever   		80-85
Chills                  42-75
Sweats         	25
Anorexia        	25-55
Weight loss     	25-35
Malaise       	25-40
Dyspnea      	20-40
Cough        	25
Stroke         	10-20
Headache      	15-40
Nau/Vomiting  	15-20
Myal/Arthralgia  	15-30
Chest Pain       	8-35
Abd. Pain       	5-15
Back Pain      	7-10
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16
Q

List of Signs associated with IE

A 
Fever        	80-90
Murmur     	80-85
Change       	10-40
Neurologic    	30-40
Embolic         	20-40 
Splenomegaly   	15-50
Clubbing        	10-20
Osler nodes     	7-10
Splinters (hemorrhage)          	5-15
Petechiae        	10-40
Janeway         	6-10
Roth Spots
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17
Q

What are the 5 classical peripheral stigmata of IE

A 
Janeway lesions
Petechiae
Splinter hemorrhages
Osler nodes 
Roth spots
18
Q

petechiae

A

Most frequently found on the conjunctivae, palate, buccal mucosa, and upper extremities

19
Q

Splinter hemorrhage

A

1-2 mm brown streaks under the nails (of greater significance when seen in the proximal nail bed)

20
Q

Janeway Lesions

A

PAINLESS, flat (macular), blanching discolorations located on the palms and soles

21
Q

Osler Nodes

A

Small, TENDER NODULES usually found on the finger and toe pads

22
Q

Roth Spote

A

Retinal hemorrhages with pale centers

23
Q

Myoctotic anuerysms occur due to emboli landing in arteries and causing a weakening/rupture of the arterial wall. Where do these aneurysms usually occur ?

A

Can occur in almost any artery ( often occurs in aorta and cerebral arteries)

24
Q

Clubbing (of digits)

A

Present in some patients with longstanding disease

Due to decreased oxygen supply to the distal extremities

25
Q

What might be found on CBC that would help rule in IE ?

A

Anemia

Leukocytosis w/ neutrophilia

26
Q

What might be found on urinalysis that would help rule in IE ?

A

Hematuria, RBC casts

27
Q

What might be found with ESR that would help rule in IE ?

28
Q

What might be found relating to CRP that would help rule in IE ?

29
Q

What percentage of patients with IE have an elevated Rheumatoid Factor ?

30
Q

Definite IE as per the Modified Duke Criteria

A 
2 major criteria 
or
1 major and 3 minors
or 
5 minor
31
Q

Possible IE as per the Modified Duke Criteria

A

1 Major and one minor
or
3 minor

32
Q

Major Criteria

A

Positive blood culture

1.Typical microorganism from two separate cultures
Persistently pos. cultures from; cultures drawn more than 12 hours apart, or all of three or majority of four with first and last drawn at least one hour apart

2.Evidence of endocardial involvement
Positive echo showing oscillating vegetation, or abscess, or dehisced prosthetic valve (starting to break free)

33
Q

Minor Criteria

A

Predisposition (prosthetic valve, heart defect)

Fever >100.4° F (>38.0° C)

Vascular phenomena (emboli, conj. hemorrhage)

Immunological phenomena( GN, +RF, Osler nodes)

Echo (consistent but not meeting major criteria)

Microbiologic evidence (cultures not meeting major criteria)

34
Q

Complications from IE include :

A

Heart Failure

Conduction disturbance (AV block)

Septic Embolism or Immunologic complexes that deposit in tissues

35
Q

What is the approximate mortality rate for an individual with IE at 6 months if treated properly ?

A

25%

If not treated, mortality is 100%

36
Q

IV antibiotics are required in all cases of IE. What is the length of time most patients will need to be on Ab’s ?

A

4-6 weeks

some respond better and can get off of them in 2 weeks

37
Q

Why is myocardial or valve ring abscess an indication for surgery ?

A

These do not respond well to surgery.

38
Q

Besides myocardial or valve rings abscess, what are the other indications for surgery with IE ?

A

Heart failure due to valvular dysfunction

Persistent bacteremia despite appropriate antimicrobial therapy (Resistance)

Recurrent embolic events despite appropriate antimicrobial therapy

Presence of large vegetations (>10mm)

Prosthetic valve dehiscence

39
Q

Indications for Emergent Surgery:

A

Acute aortic insufficiency with early closure of the mitral valve

Rupture of sinus of Valsalva into right-heart chamber

Rupture of sinus of Valsalva into pericardium

40
Q

Prophylaxis for IE is recommended for Urogenital or GI procedures in the general population ?

41
Q

Indications for IE prophylaxis

A

Prosthetic valves

Previous IE

Congenital heart disease

Unrepaired cyanotic lesions
Repaired congenital heart disease with residual
defects
Completely repaired defects, for the first six
months

Cardiac transplant patients with valvulopathy

Cardiology Exam IV (9 decks)

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