Endocarditis Flashcards
(1) ___________ is a bacterial or fungal infection of the valvular or
the endocardial surface of the heart.
(2) Underlying valvular disease disrupts blood flow and provides a nidus (nest of bacteria growth) of attachment. It is present in 50% of cases.
(3) Initiating event is the colonization of the valve by bacteria/yeast that can gain access to
the blood stream by dental/surgical procedures or respiratory, urologic, and lower GI infections.
(4) Native valve endocarditis is usually caused by Staph Aureus or, Streptococci.
(5) In IV Drug users Staph Aureus infection accounts for 60% of cases.
(6) ____ right-sides typically present with right-sided endocarditis. Other causes usually affect left sided valves.
Pathophysiology: Endocarditis
Endocarditis
________ is usually caused by Staph Aureus or
Streptococci.
Native valve endocarditis
***Staph Aureus infection accounts for 60% of cases in ________
_________ typically present with right-sided endocarditis vs. other causes usually affect left-sided valves.
IV Drug users
(1) Duration: Days to weeks to get symptoms
(2) Fever
(3) Non-specific symptoms (cough, dyspnea, arthralgias, abdominal, back, or flank pain).
(4) Characteristic peripheral lesions caused by emboli
(5) New onset heart murmur (ANY new heart murmur with a fever is Endocarditis until proven otherwise).
(6) Strokes and major systemic events occur in 25% of patients before or within the first week of antibiotic therapy.
Symptoms/Physical Findings: Endocarditis
Red, linear streaks under the nail plate and within the nail bed.
Splinter hemorrhages: Endocarditis
Painless (micro-abscesses), erythematous lesions on palms and soles.
Janeway lesions: Endocarditis
Painful (immune-complex depositions).
Osler’s nodes: Endocarditis
Exudative lesions in the retina; occurs in 25% of patients
Roth spots:
(a) Petechia on the palate, conjunctiva, or beneath fingernails.
(b) Splinter hemorrhages: Red, linear streaks under the nail plate and within the nail bed.
(c) Janeway lesions: Painless (micro-abscesses), erythematous lesions on palms and soles.
(d) Osler’s nodes: Painful (immune-complex depositions).
(e) Roth spots: Exudative lesions in the retina; occurs in 25% of patients
*Characteristic peripheral lesions caused by emboli: Endocarditis
(1) Blood cultures
(2) CBC with differential
(3) Chemistry to evaluate kidney damage.
(4) EKG: Non-diagnostic, new conduction abnormalities suggest myocardial abscess formation.
(5) Echocardiogram: Gold standard to evaluate for valvular vegetations.
Labs/Studies/EKG: Endocarditis
(1) Since blood cultures are positive in 90% of patients, it is acceptable to await blood culture results before initiating antibiotics.
(2) * If the patient is septic, Empiric therapy would be Ertapenem 1 gram IV q24 hours or Vancomycin 1 gram IV q12 hours plus Ceftriaxone 2 grams IV daily.
(3) If in heart failure, management should also focus on that.
Treatment: Endocarditis
(1) IV, O2 if saturation < 94%, Monitor.
(2) 3 sets of blood cultures.
(3) Transfer to higher level of care.
Initial Care: Endocarditis
(1) Heart failure
(2) Perivalvular abscess
(3) Pericarditis
(4) Pericardial Tamponade
(5) *Septic embolization to brain, extremities, eye, spleen, kidneys, PE, or AMI.
Complications: Endocarditis
