Endocarditis Flashcards
What is endocarditis
Inflammation of the inside lining of the heart chambers and heart valves (endocardium)
What are the different types of endocarditis
Infective or non-infective (NBTE)
Marantic endocartis - malignancy
Libman-sacks endocarditis-SLE
What is infective endocarditis
A microbial infection ( bacteria, fungi, or chlamydia) of the cardiac valves or mural surface of the endocardium, resulting in the formation of septic thrombi vegetation
What is infective endocarditis characterized by
It is characterized by prototypic lesion (vegetation), made of platelets, fibrin, microcolonies of microorganisms and inflammatory cells
What are the leading cardiac conditions
- RHD
- MVP with MR
- Degenerative AV
What are the temporal evolution classification of infective endocarditis
Acute and subacute
What are the underlying anatomy classification of infective endocarditis
Native valve endocarditis
Prosthetic valve endocarditis
What are the type of risk factor classification of infective endocarditis
Native Valve IE
Prosthetic Valve IE
Intravenous drug abuse (IVDA) IE
Nosocomial IE
Infective endocarditis could also be classified based on infecting organism (serves as basis for therapy and prognosis)
True or false
True
What are the two pathways for endocarditis
Direct pathway (direct infection by virulent organisms (Staph aureus))
Indirect pathway
What is a common mnemonic for the signs and symptoms of endocarditis
FROM JANE
Fever, Roth’s spots, Osler’s nodes. Murmur, Janeway lesions, Anemia, Nail hemorrhage (splinter hemorrhages)
What are the non-specific signs of endocarditis
Petechiae and splinter hemorrhages
What are the more specific signs of endocarditis
Janeway lesions and Osler’s nodes
What are some diagnostic investigations for endocarditis
Blood cultures
Echocardiography (TTE)
TTE findings inconclusive of IE
True or false
True
What are the ancillary investigations that could be made for IE
Haematologic: ↓Hb, ↓platelet, ↑WBC, ↑ESR
Immunology: + Rheumatoid factor, ↓complement, ANA
CT scan: Head- (infarction/abscess); Abd: splenic abscess
Urinalysis
Abdominal USG
Chest CT scan
Chest X-ray
What are the two major treatments for IE
Antibiotic therapy
Supportive care
Talk about the antibiotic treatment of IE
Start empiric antibiotic therapy for IE once blood cultures have been sampled
Switch to targeted antibiotic therapy for IE once blood culture results are available
Talk about supportive care treatment for IE
Treat urgent complications (e.g., AHF, heart block) and the underlying cause (e.g., removal of infected central lines)
What are some complications of IE
Acute Heart failure, Stroke, Lung abscess, AVB or BBB, Myocardial infarction, Myocarditis, pericarditis, Myocardial abscess, Brain Abscess, Septic Arthritis, Discitis, Spondylitis, Osteomyelitis, Glomerulonephritis, Renal infarct and abscess, Splenic abscess and infarct, Meningitis and/or encephalitis, Embolic, Local spread of infection, Metastatic spread of infection, Formation of complexes, glomerulonephritis and arthritis
Which drug route of administration is preferred in treatment of IE due to erratic absorption of oral agents
Parenteral
Mention one antibiotic used to treat IE (Monitor for renal effects due to low toxic therapeutic ratio)
Aminoglycosides (eg. Gentamicin)
What are some indications for surgery in an IE
Perivascular invasive disease
Uncontrolled infection despite maximal antimicrobial therapy
Presence of prosthetic valve endocarditis unless late infection
CCF
What are the surgical procedures in an IE
Valve replacement
Valve repair
