Endocarditis Flashcards
What is Infective endocarditis?
Infection of endovascular structures of the heart leading to formation of vegetations
Often associated with destruction of the underlying cardiac tissues
What is a vegetation?
thrombotic debris and microorganisms
List 4 risk factors for IE
- Previous history of infective endocarditis
- Rheumatic valve disease
- Prosthetic valves
- IVDU
- Poor dentition and dental infections
What bacteria and what valve is commonly a/w IVDU endocarditis
- Staph. aureus
- Tricuspid valve
Which valve is typically infected in IE in previously normal valves (not IVDU)
Mitral
What is the most common bacterial cause of IE
Staphylococcus aureus
Others: Strep viridans, Staph epidermidis, Streptococcus bovis, HACEK organisms
What are HACEK organisms?
Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
Clinical presentation of IE
Patient with a fever and new murmur should always raise suspicion of IE
Other symptoms: anorexia, weight loss, headache, myalgia, arthalgia, night sweats, abdo pain, cough, pleuritic pain
List 4 clinical signs of IE
- Janeway lesions
- Osler nodes
- Splinter haemorrhages
- Roth spots
Compare Janeway lesions vs Osler nodes
Janeway - nontender macules on palms and soles
Osler - tender subcutaneous nodules on the finger pads and toes
What are Roth Spots?
Exudative haemorrhagic retinal lesions with pale centres
What ECG finding may be indicative of IE
PR prolongation or complete AV block - sign of aortic root abscess
Note: PR prolongation in IE is an indication for surgery
What criteria(s) are used of IE?
- Pathological criteria
- The modified Duke criteria (clinical criteria)
What is the Pathological criteria of IE
- Microorganism on culture of a specimen from vegetation, embolism or intracardiac abscess OR
- Pathological lesions: vegetation or intracardiac abscess; confirmed by histology
What are the 2 ‘Major’ dukes criteria
- Blood culture positive for IE
- Echocardiogram positive for IE
What are the 5 ‘Minor’ dukes criteria
- Predisposition
- Fever > 38.0°C
- Vascular phenomena
- Immunological phenomena
- Microbiological evidence
What defines a definite IE using the Dukes criteria?
- pathological criteria positive OR
- 2 major OR
- 1 major + 3 minor OR
- All 5 minor
Treatment of IE?
long term IV antibiotics (~6wks)
List 5 indications of surgery in IE
- Severe valvular incompetence
- Aortic abscess (↑PR interval)
- Resistant infections
- Refractory cardiac failure
- Recurrent emboli after Abx therapy
Is IE Prophylaxis recommended for at-risk patients undergoing interventional procedures?
NO
Complications of IE
- Acute valvular insufficiency causing HF
- Neurologic eg. stroke, abscess
- Embolic eg. infarction of kidneys, spleen or lung
- Infection eg. osteomyelitis, septic arthritis
What are the 4 major forms of vegetative endocarditis?
- Rheumatic fever
- IE
- Non-bacterial thrombotic endocardits
- Libman-Sacks endocarditis
What is Libman-Sacks endocarditis?
Endocarditis of SLE
