Endocarditis Flashcards
Define endocarditis
inflammation of the endocardium, the membranes lining the chambers of the heart and covering the cusps of the heart valves
Define infective endocarditis (IE)
Infection of the heart valves by various microorganisms
How do you classify endocarditis?
- Based on the anatomical site of infection
- Based on the clinical presentation
- Based on the organism identified
What are the types of anatomical sites for endocarditis?
- Native valve
- Prosthetic valve
- Left side
- Right side
What are the clinical presentations for acute bacterial endocarditis?
- High fevers
- Systemic toxicity
- Leukocytosis
- Death within days if left untreated
What are the clinical presentations for subacute bacterial endocarditis (SBE)?
- Slow, low-grade fever
- Night sweats
- Weight loss
- Vague systemic complaints
(T/F) - SBE occurs in previous valvular damage patients
TRUE
(T/F) - SBE and acute are treated differently
FALSE - treated the same
Which gender is affected by endocarditis more?
Men - 2x
Which age-group is affected by endocarditis more?
Age > 50 yo
What are the predisposing risk factors of endocarditis?
- Presence of prosthetic heart valve
- Previous endocarditis
- DM
- Health-care related exposure
- Congenital heart disease with cyanosis
- Acquired valvular dysfunction
- Hypertrophic cardiomyopathy
- Mitral valve prolapse with regurgitation
- Chronic IV access
- IV drug abuse (IVDA)
(T/F) - In 25% of the cases, predisposing risk factors are absent
TRUE
What are the most common organisms associated with endocarditis?
- Staph
- Streptococci
- Enterococci
- HACEK organisms
What is the most common route of obtaining IE?
Hematogenous spread requiring sequential occurrence of several factors
What are the several factors in the sequential occurrence that develops IE?
- Endothelial surface of the heart is damaged
- Sterile platelet-fibrin thrombi form surface of damaged endothelial cells
- Bacteremia gives organisms access to and results in colonization of the endothelial surface
- After colonization of endothelial surface, a “vegetation” of fibrin, platelets and bacteria form
Which bacterial organisms adhere to endothelial surface due to their production of adherence products?
- Staph
- Strep
- Entero
What are secondary complications due to vegetation formation?
- Heart failure
- Septic emboli
- Antibody complexes can form and deposit in organs causing local inflammation and damage
(T/F) - Clinical presentation of endocarditis is usually variable and nonspecific
TRUE
What is the most common sign and/or Sx of endocarditis?
- Fever
- Heart murmur (sign)
What laboratory finding is the hallmark finding for endocarditis?
Positive blood cultures
What are nonspecific lab findings for endocarditis?
- Anemia
- Normal or slightly elevated WBC with a mild left shift
- Elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
Which diagnostic tests can be performed to confirm endocarditis?
- Transesophageal echocardiogram (TEE) [used more often]
- Transthoracic echocardiogram (TTE)