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2 - Cardiovascular Medicine > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

Definition endocarditis

A

invasion and multiplication of microorganisms on or within endocardium or on prosthetic materials within and around cardiac structures

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2
Q

Complications of endocarditis

A

valvular dysfunction
Localized sepsis
Generalized sepsis
Embolization sites

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3
Q

Main organisms causing endocarditis

A

Gram positive mostly - Staph, strep, enterococcus - 80%
Fungi 2%
Gram negative uncommon
HACEK 2% ( hemophilus sp., aggregatibacter sp., cardiobacterium hominis, eikenella corrodens, kingella sp.)
Viral
Rikettsial

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4
Q

Different ways to classify endocarditis

A

Time of onset (acute, subacute )
Activity of infection / inflammation (active , healed)
Type of surface involved ( native , prosthetic valve endocarditis )

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5
Q

Events leading to injury to Endocardial surface

A

Pre existing valvular lesion like in rheumatic valvulitis

Jet effect of blood flow through PDA, restrictive VSD , bicuspid aortic valve

Trauma from in dwelling catheters/electrodes

IV drug abuse

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6
Q

How is venturi effect applied in endocarditis

A

Vegetation’s develop when blood travels from high pressure to low pressure area which happens according to venturi effect in constricted section of a pipe. So more changes of vegetations at stenosed valves, PDA

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7
Q

Where can you find vegetations in the heart

A

Atrial side of incompetent AV valves
Ventricular surface of incompetent semilunar valve

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8
Q

People at risk of infective endocarditis

A

intravenous drug abusers 30-40 yo
Elderly (more than 65) with valve prostheses or chronic Haem catheter

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9
Q

types of IE

A

Left sided native valve endocarditis - 70%
Left sided prosthetic valve 20%
Prosthetic valve endocarditis PVE 1-5%
Right sided IE 5-10%

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10
Q

Main causes of right sided IE

A

IVDA
Permanent pacemakers
Implantable cardioverter defribillator
Central venous catheter

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11
Q

Valves affected from most common to least common

A

MV>AV>MV+AV+TV

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12
Q

In IVDA , this valve is involved in 50% of cases

A

Tricuspid valve

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13
Q

Main symptoms of IE

A

Fever 90%
Anorexia
Weight loss
Myalgia
Heart failure symptoms

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14
Q

Main signs in IE

A

Heart murmurs 85%
Oslers nodes
Roths spots
Jane ways lesions

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15
Q

Vascular phenomenon in IE

A

Major arterial emboli
Septic pulmonary infarcts
Infectious aneurysm
Intracranial hemorrhage
Conjunctival hemorrhages
Jane ways lesions

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16
Q

Main immunological phenomenon in IE

A

Glomerulonephritis
Oslers nodes
Roths spots

17
Q

What is a Roth spot

A

Hemorrhages with white or pale centres

18
Q

ECG findings in IE

A

New onset heart block
MI due to emboli
Atrial fibrillation

19
Q

Imaging techniques used in IE

A

CXR
Echo
Multislice CT scan
MRI
PET

20
Q

Lab investigation in IE

A

Blood culture from peripheral vein sample
Leucocytosis
Anemia

21
Q

Main reasons of negative blood cultures IE in 31% of patients

A

Due to previous antibiotic administration
Infection by fastidious organism (Bartonella spp , Coxiella burnetii , Aspergillus spp)

22
Q

Favored antibiotics regimen in IE

A

Bactericidal regimen

23
Q

Drug treatment is longer in PVE or NVE

A

PVE wit more than 6 weeks treatment compared to NVE with 2-6weeks treatment

24
Q

Drug that should be included in regimen if there is staph PVE

A

Rifampicin

25
Q

Empirical treatment of IE in community acquired NVE or late PVE

A

Ampicillin +. Flucloxacillin / oxacillin + gentamicin
Vancomycin + gentamicin when allergic to penicillin

26
Q

Empirical treatment of IE in nosocomial/ non nosocomial healthcare related or early PVE

A

Vancomycin + gentamicin + rifampicin

27
Q

Antibiotic treatment for strep

A

Penicillin /amoxicillin/ ceftriaxone
Vancomycin if penicillin allergy
If resistant strain add gentamicin

28
Q

Antibiotic staph treatment

A

NVE - Flucloxacillin/ oxacillin /Clindamycin + co-trim (vancomycin if penicillin allergy )

PVE - Flucloxacillin or Ox + gentamicin + rifampicin (vancomycin in penicillin allergy )

29
Q

Antibiotic treatment for enterococcus

A

Amoxicillin + gentamicin
Ampicillin + ceftriaxone

30
Q

Antibiotic treatment for HÁČEK

A

Ceftriaxone
Thrid generation cephalosporin and quinolones

31
Q

Fungi treatment

A

Oral azole - fluconazole for candida, voriconazole for aspergillus for life

32
Q

What are the indications for surgery

A

emergency in 24h
Urgent less than 7days
Elective to allow 1-2 weeks of antibiotis
Heart failure
Uncontrolled infection
Prevention of emboli events

33
Q

Classification of IE

A

Subacute endocarditis
Acute endocarditis
Post op endocarditis

2 - Cardiovascular Medicine (16 decks)

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