Endocarditis

Question 1

What is Infective Endocarditis

Answer 1

A destructive process that affects mostly valves, leads to CHF, embolization and death if untreated

Question 2

How to diagnose Endocarditis

Answer 2

Blood Tests 95% of cases

Question 3

What are the causes of Endocarditis

Answer 3

Bacterial - Staphylococcus aureus and Streptococcus viridans cause > 80%, Yeast or Fungal infections

Question 4

Where does Endocarditis occur?

Answer 4

Mostly valves, also paps or endocardial surface of ventricles, catheters, pacemaker wires, prosthetic materials

Question 5

What is the classic presentation of Endocarditis?

Answer 5

Vegetations usually on the low pressure side of the valve(flow side) which is the atrial side for MV/TV and ventricle for PV/AOV

Question 6

What does Endocarditis look like?

Answer 6

Shaggy smudgy, pedunculated, usually highly mobile and can seed other areas. Vegetations vary widely in appearance

Question 7

Subacute Endocarditis

Answer 7

Subtle presentation- Usually by streptococcus viridans carrying a low grade fever, fatigue, weight loss, cough, weakness, patient may not recognize seriousness of it

Question 8

Acute Endocarditis

Answer 8

Usually staphylococcus aureus, carrying a high fever, rapid onset of symptoms like heart murmurs and can lead to CHF symptoms

Question 9

Acute Endocarditis continued

Answer 9

Embolization signs with left heart involvement- petechiae and purpuric skin lesions and Janeway lesions, TIA, CVA

Question 10

Purpuric skin lesions and petechiae

Answer 10

clumps on legs

Question 11

Janeway lesions

Answer 11

on palms and soles of the feet

Question 12

How to diagnose Endocarditis?

Answer 12

FUO, + new murmurs+ blood cultures

Question 13

Blood cultures not always accurate for endocarditis

Answer 13

multiple samples needed, antibiotics for 2+ days affects results and fungal etiologies often have negative cultures

Question 14

What size veg can echo detect?

Answer 14

> 3mm

Question 15

What size veg can TEE detect?

Answer 15

> 1mm

Question 16

If no veg does that mean no endocarditis?

Answer 16

No, must follow DUKE criteria

Question 17

DUKE criteria

Answer 17

• 2 major criteria - + blood cultures, echo findings
• 1 major & 3 minor - fever, predisposing conditions or vascular evidence, Janeway lesions, Oslers nodes
• minor criteria

Question 18

Complications of endocarditis

Answer 18

Valvular regurgitation that worsens as lesion enlarges, valvular destruction, CHF from severe or acute regurg

Question 19

Perivalvular abscesses (MV/AOV ring)

Answer 19

extensions of active infective disease, echolucent or echodense areas adjacent to valve apparatus, fistula formation, evaluate with color and doppler carefully, TEE

Question 20

Perivalvular abscesses - what can happen

Answer 20

Emobization -TIA, CVA, LV wma- pulmonary embolus, pericarditis and pericardial effusion can result, mycotic aneurysm can occur- echolucent but hard to tell from abscess

Question 21

Can Mechanical and tissue valves be affected by Infective endocarditis?

Answer 21

Yes - shadows and artifacts may impair visualization and perivalvular leaks or dehiscence may cause a rocking motion of the sewing ring

Question 22

Left ventricular function with Infective Endocarditis

Answer 22

Usually normal or hyperdynamic, When acute IE causes severe, acute regurg it creates a sudden LVVO pattern resulting in dilation and a hyperdynamic state

Question 23

Endocarditis on M-Mode

Answer 23

• Oscillations may be detected(increased echos from the veg fluctuating in the blood flow) AOV veg oscillations may be detected in the LV
• AI due to AOV veg may cause flutter of the AMVL
• When severe regurg occurs LVVO happens thus LVE with hyperkinesis leading to LVEDP

Question 24

With Doppler rule out

Answer 24

Regurg and stenosis