Endocarditis Flashcards

1
Q

Define endocarditis

A

inflammation of the endocardium, the membranes lining the chambers of the heart and covering the cusps of the heart valves

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2
Q

Define infective endocarditis (IE)

A

Infection of the heart valves by various microorganisms

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3
Q

How do you classify endocarditis?

A
  • Based on the anatomical site of infection
  • Based on the clinical presentation
  • Based on the organism identified
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4
Q

What are the types of anatomical sites for endocarditis?

A
  • Native valve
  • Prosthetic valve
  • Left side
  • Right side
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5
Q

What are the clinical presentations for acute bacterial endocarditis?

A
  • High fevers
  • Systemic toxicity
  • Leukocytosis
  • Death within days if left untreated
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6
Q

What are the clinical presentations for subacute bacterial endocarditis (SBE)?

A
  • Slow, low-grade fever
  • Night sweats
  • Weight loss
  • Vague systemic complaints
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7
Q

(T/F) - SBE occurs in previous valvular damage patients

A

TRUE

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8
Q

(T/F) - SBE and acute are treated differently

A

FALSE - treated the same

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9
Q

Which gender is affected by endocarditis more?

A

Men - 2x

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10
Q

Which age-group is affected by endocarditis more?

A

Age > 50 yo

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11
Q

What are the predisposing risk factors of endocarditis?

A
  • 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)
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12
Q

(T/F) - In 25% of the cases, predisposing risk factors are absent

A

TRUE

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13
Q

What are the most common organisms associated with endocarditis?

A
  • Staph
  • Streptococci
  • Enterococci
  • HACEK organisms
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14
Q

What is the most common route of obtaining IE?

A

Hematogenous spread requiring sequential occurrence of several factors

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15
Q

What are the several factors in the sequential occurrence that develops IE?

A
  1. Endothelial surface of the heart is damaged
  2. Sterile platelet-fibrin thrombi form surface of damaged endothelial cells
  3. Bacteremia gives organisms access to and results in colonization of the endothelial surface
  4. After colonization of endothelial surface, a “vegetation” of fibrin, platelets and bacteria form
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16
Q

Which bacterial organisms adhere to endothelial surface due to their production of adherence products?

A
  • Staph
  • Strep
  • Entero
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17
Q

What are secondary complications due to vegetation formation?

A
  • Heart failure
  • Septic emboli
  • Antibody complexes can form and deposit in organs causing local inflammation and damage
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18
Q

(T/F) - Clinical presentation of endocarditis is usually variable and nonspecific

A

TRUE

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19
Q

What is the most common sign and/or Sx of endocarditis?

A
  • Fever

- Heart murmur (sign)

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20
Q

What laboratory finding is the hallmark finding for endocarditis?

A

Positive blood cultures

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21
Q

What are nonspecific lab findings for endocarditis?

A
  • Anemia
  • Normal or slightly elevated WBC with a mild left shift
  • Elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
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22
Q

Which diagnostic tests can be performed to confirm endocarditis?

A
  • Transesophageal echocardiogram (TEE) [used more often]

- Transthoracic echocardiogram (TTE)

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23
Q

What are the peripheral manifestations that could occur due to endocarditis?

A
  • Osler’s nodes
  • Janeway lesions
  • Splinter hemorrhages
  • Petechiae
  • Clubbing of the fingers
  • Roth spot’s
24
Q

Match the peripheral manifestation from the description below:
Small, erythematous, hemorrhagic lesions, painless

A

Petechiae

25
Q

Match the peripheral manifestation from the description below:
Hemorrhagic, painless plaques on the palms of the hands or soles of the feet

A

Janeway lesions

26
Q

Match the peripheral manifestation from the description below:
Proliferative changes in the soft tissue about the terminal phalanges observed in long standing endocarditis

A

Clubbing of the fingers

27
Q

Match the peripheral manifestation from the description below:
Purplish, erythematous SQ papules or nodules on the pads of the fingers and toes; painful and tender

A

Osler’s nodes

28
Q

Match the peripheral manifestation from the description below:
Retinal infarct with central pallor and surrounding hemorrhage

A

Roth’s spots

29
Q

Match the peripheral manifestation from the description below:
Thin, linear hemorrhages found under the nail beds of fingers or toes

A

Splinter hemorrhages

30
Q

Which peripheral manifestations are not specific for infective endocarditis?

A
  • Osler’s nodes

- Splinter hemorrhages

31
Q

What criteria is used to diagnose a major or minor criteria?

A

Modified Duke

32
Q

What things would consider a patient to be under a major criteria?

A
  • Positive blood culture test (separate 2 times)

- Evidence of endocardial involvement with diagnostic tests

33
Q

What is considered definite IE?

A

Pt consist of

  • 2 major criteria OR
  • 1 major and 3 minor criteria OR
  • 5 minor criteria
34
Q

What is considered possible IE?

A

Pt consist of

  • 1 major and 1 minor criteria OR
  • 3 minor criteria
35
Q

A patient who is susceptible to PCN and has streptococci endocarditis in their native valve would be given what treatment? For how long?

A
  • Aqueous crystalline PCN G or ceftriaxone for 4 weeks
  • Aqueous crystalline PCN G or ceftriaxone + gentamycin for 2 weeks
  • Vancomycin for 4 weeks
36
Q

(T/F) - Vancomycin is only given if patient cannot tolerate PCN or ceftriaxone

A

TRUE

37
Q

A patient who is relative resistant to PCN and has group A streptococci endocarditis in their native valve would be given what treatment? For how long?

A
  • Aqueous crystallin PCN G or ceftriaxone for 4 weeks with gentamycin for 2 weeks
  • Vancomycin for 4 weeks
38
Q

A patient who is resistant to PCN and has group A streptococci endocarditis in their native valve would be given what treatment? For how long?

A

Vancomycin + gentamycin for 6 weeks

39
Q

A patient who is susceptible to PCN and has group A streptococci endocarditis in their prosthetic valve would be given what treatment? For how long?

A
  • Aqueous crystalline PCN G or ceftriaxone for 6 weeks +/- gentamicin (clinician’s choice) for 2 weeks
  • Vancomycin for 6 weeks
40
Q

A patient who is relative or fully resistant to PCN and has group A streptococci endocarditis in their prosthetic valve would be given what treatment? For how long?

A
  • Aqueous crystalline PCN G or ceftriaxone + gentamicin for 6 weeks
  • Vancomycin for 6 weeks
41
Q

A patient with an MSSA infection and has staphylococcal endocarditis in their native valve would be given what treatment? For how long?

A
  • Oxacillin or nafcillin for 6 weeks

- Cefazolin for 6 weeks (if patient is allergic to PCN)

42
Q

A patient with an MRSA infection and has staphylococcal endocarditis in their native valve would be given what treatment? For how long?

A
  • Vancomycin for 6 weeks

- Daptomycin for 6 weeks

43
Q

A patient with an MSSA infection and has staphylococcal endocarditis in their prosthetic valve would be given what treatment? For how long?

A
  • Nafcillin or oxacillin for 6 weeks or more AND
  • Rifampin for 6 weeks or more AND
  • Gentamicin for 2 weeks
44
Q

A patient with an MRSA infection and has staphylococcal endocarditis in their prosthetic valve would be given what treatment? For how long?

A
  • Vancomycin for 6 weeks or more AND
  • Rifampin for 6 weeks or more AND
  • Gentamicin for 2 weeks
45
Q

A patient susceptible to PCN, gentamicin, vancomycin and has enterococcal endocarditis in their prosthetic or native valve would be given what treatment? For how long?

A
  • Ampicillin or aqueous PCN G + gentamicin for 4-6 weeks
  • Ampicillin or ceftriaxone for 6 weeks
  • Vancomycin + gentamicin for 6 weeks
46
Q

Which regimen is only given if the CrCl baseline < 50 mL/min or decreases < 50 with a gentamicin-containing regimen?

A

Ampicillin or ceftriaxone for 6 weeks if a patient has enterococcal endocarditis and are susceptible to PCN, gentamicin, and vancomycin.

47
Q

A patient susceptible to PCN but resistant to aminoglycosides and has enterococcal endocarditis in their prosthetic or native valve would be given what treatment? For how long?

A

Ampicillin or ceftriaxone for 6 weeks

48
Q

A patient susceptible to vancomycin and aminoglycosides but resistant to PCN and has enterococcal endocarditis in their prosthetic or native valve would be given what treatment? For how long?

A

Vancomycin + gentamicin for 6 weeks

49
Q

A patient resistant to PCN, vancomycin, aminoglycosides and has enterococcal endocarditis in their prosthetic or native valve would be given what treatment? For how long?

A

Linezolid or daptomycin for > 6 weeks

50
Q

A patient with HACEK endocarditis in their prosthetic or native valve would be given what treatment? For how long?

A

-Ceftriaxone
- Ampicillin/sulbactam
- Ciprofloxacin
If it’s a native valve infection it’s for 4 weeks long
If it’s a prosthetic valve infection it’s for 6 weeks long

51
Q

(T/F) - HACEK endocarditis can be given another 3rd or 4th cephalosporin instead of ceftriaxone

A

TRUE

52
Q

(T/F) - Ciprofloxacin is a fluoroquinolone that can be given for HACEK endocarditis as an alternative for beta-lactam intolerance

A

TRUE - but other fluoroquinolones can be given as well

53
Q

Can surgery be used to help treat endocarditis in a patient?

A

Yes

54
Q

Which patients are indicated to have surgery for endocarditis?

A
  • HF
  • Persistent fever
  • Recurrent embolic events
  • Prosthetic valves
  • Abscess
  • Fungal IE
  • Ineffective antibiotic therapy
55
Q

What is done in surgery to help reduce/treat endocarditis?

A

Remove and replace valve(s) to remove infected tissue and restore hemodynamic function

56
Q

Are there any prevention therapy for patients to reduce recurrent endocarditis events?

A

Yes

57
Q

Who are high risk patients who are allowed to have prevention therapies?

A
  • Prosthetic heart valve
  • Previous IE
  • Congenital heart disease (CHD)
  • Cardiac transplant recipient who develops cardiac valvulopathy