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Week 5 - Cardiology > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

What is endocarditis?

A
  • Infection of the endocardium
  • formation of a vegetation
  • Results in damage to cusp of valves
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2
Q

What are the valves and where are they?

A
  • Mitral (from LA to LV)
  • Aortic (LV to aorta)
  • Tricuspid (RA to RV)
  • Pulmonary (RV to pulmonary artery)
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3
Q

What is a vegetation made of?

A
  • Platelets
  • WBC
  • Fibrin mesh
  • RBC debris
  • Organsims embedded in fibrin mesh
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4
Q

What is a vegetation made of?

A
  • Platelets
  • WBC
  • Fibrin mesh
  • RBC debris
  • Organsims embedded in fibrin mesh
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5
Q

What is a vegetation made of?

A
  • Platelets
  • WBC
  • Fibrin mesh
  • RBC debris
  • Organsims embedded in fibrin mesh
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6
Q

What is quorum sensing?

A

How organisms communicate with each other. They produce chemical messages which tell organisms to divide or become biochemically inert

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7
Q

Why does quorum sensing make infection hard to treat?

A

They can signal to become inert which means that antimicrobials will be less effective against them

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8
Q

What are the gram positive bacteria that cause endocarditis?

A 
•Stapphylocci 
- coagulase negative staphylococci 
- Staph aureus (MSSA and MRSA) 
•Streptococci
- strep. viridans 
- enterococci
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9
Q

What are the gram negative bacteria that cause endocarditis?

A
  • HACEK organisms
  • Pseudomonas aeruginosa
  • Enterobacteriales (e.g. E coli)
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10
Q

What are the risk factors for native endocarditis?

A

•Underlying valve abnormalities: 55-75%

  • aortic stenosis
  • mitral valve prolapse
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11
Q

Which valve is most commonly affected in IVDU with endocarditis?

A

Tricuspid valve

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12
Q

What are the clinical features of an acute endocarditis?

A
  • toxic presentation
  • Progressive valve destruction and metastatic infection developing in days to weeks
  • Most commonly s. aureus
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13
Q

What are the clinical features of chronic endocarditis?

A
  • Mild toxicity
  • Presentation over weeks to months
  • Rarely leads to metastatic infection
  • Most commonly strep viridians or enterococcus
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14
Q

What are the 3 main groups of clinical features of endocarditis?

A
  • Early manifestations of infection
  • Embolic events
  • Late effects of infection
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15
Q

Explain the early manifestations of endocarditis

A
  • Incubation approx 2 weeks but longer in PVE
  • A fever and murmur (especially if new) is infective endocarditis until proven otherwise
  • Fever is the most common sign and murmurs is present in 80-85%
  • Malaise
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16
Q

Which type of endocarditis is a murmur often absent in?

A

Tricuspid endocarditis

17
Q

Explain embolic events of endocarditis

A 
•Can takes days-weeks to occur 
•Seen earlier in acute endocarditis 
•Small emboli 
 - petechia 
 - splinter haemorrhages 
 - haematuria 
•Large emboli 
 - CVA (stroke) 
 - Renal infarction 
•Right sided endocarditis - septic pulmonary emboli
18
Q

Explain the long term effects of endocarditis

A 
•Immunological reaction: 
 - splenomegaly 
 - nephritis 
 - vasculitic lesions of the skin and eye 
 - clubbing 
•Tissue damage: 
 - valve destruction 
 - valve abscess

•Osler’s nodes

19
Q

What are the signs of endocarditis in the hands?

A
  • Clubbing
  • Splinter haemorrhage
  • Osler’s nodes
20
Q

When should you consider IE as a diagnosis?

A
  • In all patients with a S.aureus bacteraemia
  • IVDU with any positive blood culture
  • All patients with prosthetic valves and positive blood cultures
21
Q

Explain the diagnosis of endocarditis

A

•3 sets of blood cultures (10ml bottles)
- Take samples before antibiotics using aseptic technique
•Echocardiograph: trans thoracic or trans oesophageal (invasive but higher sensitivity)
•Duke criteria (2 major/1 major + 3 minor/5 minor criteria)

22
Q

Explain Duke criteria

A

•Major

  • Typical organism in 2 separate blood cultures
  • Positive echocardiogram or new valve regurgitation

•Minor

  • Predisposition (heart condition or IVDU)
  • Fever >38 degrees
  • Vascular phenomena (e.g. septic emboli)
  • immunological phenomena (e.g. osler nodes)
  • Positive blood cultures (not meeting the major criteria)
23
Q

What is the management of endocarditis?

A
  • Antimicrobial therapy

* Surgical intervention

24
Q

What are the indications for surgery for endocarditis?

A
  • Heart failure
  • Uncontrollable infection - abscess/ persisting fever + positive bloods for>7 days/ infection caused by multi drug resistant organisms
  • Prevention of embolism - large vegetations and embolic episode
25
Q

What is the duration of therapy for native valve endocarditis?

A

4 weeks

26
Q

What is the duration of antimicrobial therapy for prosthetic valve endocarditis?

A

6 weeks

27
Q

What is the antimicrobial therapy for streptococcus species?

A
  • Benzylpenicillin

* Gentamicin

28
Q

What is the antimicrobial theory for enterococcus species?

A
  • Amoxicillin or Vancomycin

* Gentamicin

29
Q

What is the antimicrobial therapy for S aureus (MSSA)?

A
  • Flucloxacillin

* Gentamicin

30
Q

What is the antimicrobial therapy for staph aureus (MRSA)?

A
  • Vancomycin

* Gentamicin

31
Q

What is the antimicrobial therapy for CoNS?

A
  • Vancomycin
  • Gentamicin
  • Rifampicin

Week 5 - Cardiology (8 decks)

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