Endocarditis

Question 1

Causes of Right sided endocarditis?

Answer 1

The causes of right-sided IE are as follows:
Staphylococcus aureus, 70%
Streptococci (as a group), 5 to 30%
Enterococci (as a group), 2 to 5%
Fungi and Gram-negative bacilli, less than 1%
Culture-negative endocarditis, less than 1%

Question 2

What are the risk factors for Right sided endocarditis?

Answer 2

Injected-drug use
Cardiac devices, such as a right-sided pacemaker or defibrillator
Intravascular devices, such as a central line, balloon pump, or ventricular-assist device
Right-sided cardiac anomalies due to congenital heart disease

Question 3

Endocarditis with Group D strep (aka gallolyticus) warrants and evaluation with?

Answer 3

Colonoscopy for GI malignancy

Question 4

Duke Criteria:

Answer 4

Definite IE:
Injected-drug use
Cardiac devices, such as a right-sided pacemaker or defibrillator
Intravascular devices, such as a central line, balloon pump, or ventricular-assist device
Right-sided cardiac anomalies due to congenital heart disease

Possible IE:
1 major and 1 minor criteria
3 minor criteria

Not IE:
A firm alternative diagnosis is established
Resolution of clinical manifestations ≤4 days after beginning antibiotic therapy
No evidence of endocarditis is found at surgery or autopsy after antibiotic therapy for 4 days or less
Clinical criteria for possible or definite IE are not met

Question 5

What are the major and minor Duke Criteria:

Answer 5

Major Criteria:

Bacteremia: organisms that are known to cause endocarditis (Staphylococcus aureus, Streptococcus species, Enterococcus species, etc.) are obtained from 2 separate blood cultures
Heart involvement: echocardiogram with valvular vegetation, new regurgitation, prosthetic-valve dehiscence or abscess

Minor Criteria:
Intravenous drug use or predisposing heart condition (congenital heart disease or valvular replacement)
Fever exceeding 38°C (100.4°F)
Vascular phenomena: arterial emboli, septic infarcts, mycotic aneurysms, Janeway lesions, intracranial hemorrhage
Immune-mediated phenomena: glomerulonephritis, Osler nodes, Roth spots (in the eyes)
Bacteremia: only if the presentation does not meet major criteria excepting organisms that do not usually cause endocarditis or are usually contaminants, such as coagulase-negative staph

Question 6

What is Libman-Sacks Endocarditis?

Answer 6

Libman–Sacks endocarditis (LSE) is a form of non-bacterial endocarditis that is seen in association with systemic lupus erythematosus (SLE), antiphospholipid syndrome, and malignancies. It is one of the most common heart-related manifestations of lupus (the most common being pericarditis)

Affected persons most commonly present with embolisms secondary to dislodged vegetations. However, in some cases, severe valvular dysfunction may develop.

The vegetations are small and formed from strands of fibrin, neutrophils, lymphocytes, and histiocytes. Vegetations are most often small-to-moderate in size (<10mm), but may sometimes be large (>10mm). The mitral valve is typically affected, and the vegetations occur on the ventricular and atrial surface of the valve. Though the left-sided heart valves (mitral and aortic) are most commonly affected, any of the heart valves as well as adjoining structures may become involved