Deck 5 Flashcards
Q. What occurs in infective endocarditis? Which patients/cases are most likely to develop endocarditis?
A. Infection of heart valve/s or other endocardial lined structures within the heart (such as septal defects, pacemaker leads, surgical patches etc), previously known as subacute bacterial endocarditis
B. Patients with abnormal valves (regurgitant, prosthetic valves)
C. Surgery: introduction of infectious material into the blood steam or directly onto the heart
D. Those who have had rheumatic fever in the past (childhood)
E. IV drug users
F. The elderly
Q. Describe the pathogenesis of endocarditis
A. Microbial adherence
B. Bacterial adherence to platelet-fibrin nidus
C. Hallmark of IE is vegetation; lumps of infected fibrin/clot hanging off the heart valves
Q. How does endocarditis present? What are the clinical manifestations?
A. Depends on site, organism, etc
B. Signs of systemic infection (fever, sweats, etc)
C. Embolisation; stroke, pulmonary embolus, bone infections, kidney dysfunction, myocardial infarction
D. Valve dysfunction; heart failure, arrhythmia
E. Wide range of symptoms…
F. Heart murmurs are frequent, but may be hard to hear (15%+ of pts)
G. Right-sided endocarditis: JVP evidence of tricuspid regurgitation.
H. Peripheral stigmata (becoming rarer, more common in less virulent, more longstanding disease)
Q. Describe Duke’s criteria for IE diagnosis
A. +ve blood culture for bacteria that can cause endocarditis from 2 blood cultures
B. Fever
C. Vascular phenomena
Q. Which two types of Echocardiology can be used to diagnose IE? What are the differences?
A. Transthoracic echo (TTE). Safe, non-invasive, no discomfort, often poor images so lower sensitivity
B. Transoesophageal (TOE/TEE). Excellent pictures as long as you don’t mind having a big tube pushed down your throat. Patients rarely want to have a second TOE. Generally safe but risk of perforation or aspiration. Easiest if ventilated (but never ventilate just for TOE)
Q. Describe peripheral stigmata associated with infectious endocarditis?
A. Petechiae 10 to 15% (small red or purple spot caused by bleeding into the skin)
B. Splinter hemorrhages (blood clots that run vertically under the nails)
C. Osler’s nodes (small, tender, purple, erythematous subcutaneous nodules are usually found on the pulp of the digits)
D. Janeway lesions are erythematous, macular, nontender lesions on the fingers, palm, or sole
E. Roth spots on fundoscopy - retina
Q. Describe the treatment of infectious endocarditis
A. Ant Antimicrobials; based on cultures (IV, long period)
B. Treat complications; arrhythmia, heart failure, heart block, embolisation
C. Surgery: if infection cannot be cured by antibiotics, other complications, to remove infected devices/valves or vegetations before they embolise
