Endocarditis

Question 1

Infective Endocarditis

Answer 1

Infective endocarditis (IE) refers to a microbial infection within the endothelium of the heart. Vegetations form and adhere to the endothelial structures. The heart valves are most often involved, but the disease may also occur within a septal defect, on the chordae tendineae, or on the mural endocardium. The majority of IE cases are the result of bacterial infections.

Question 2

IE Causes

Answer 2

Staph. Aureus
Strep Pneumoniae
N. gonorrhoeae

Rheumatic heart disease as a cause is rare in the US

Question 3

IE risk by Patient

Answer 3

IV drug users
Patients with prosthetic heart valve
Patients with structural heart disease
Dialysis / wound care

Question 4

IE Presentation

Answer 4

Highly variable by causative organism
Acute rapidly progressing infection or subacute
Fever (less common in older patients)
Neurological Findings
Opthalmologic (roth spots and lesions can occur)
Heart murmurs
PE
Arthritis / Myalgia

Question 5

Classic IE Presentation

Answer 5

Fever, new murmur, pulmonary infiltrates, fatigue

Question 6

Suspected IE Tests

Answer 6

Blood Cultures (x3) are critical before antibiotics!!
CBC, CRP, ESR
EKG
Echocardiogram to identify vegetations!

Question 7

IE Management

Answer 7

Antibiotics, usually multi-agent (Pen-G and Ceftriaxone)

Refer to infectious disease

Question 8

IE Red Flags

Answer 8

IE diagnosis is made on history, exam, blood cultures, EKG, Duke Criteria, Imaging