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Medicine > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

What is endocarditis

A

Inflammation of the inside lining of the heart chambers and heart valves (endocardium)

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2
Q

What are the different types of endocarditis

A

Infective or non-infective (NBTE)
Marantic endocartis - malignancy
Libman-sacks endocarditis-SLE

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3
Q

What is infective endocarditis

A

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

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4
Q

What is infective endocarditis characterized by

A

It is characterized by prototypic lesion (vegetation), made of platelets, fibrin, microcolonies of microorganisms and inflammatory cells

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5
Q

What are the leading cardiac conditions

A
  1. RHD
  2. MVP with MR
  3. Degenerative AV
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6
Q

What are the temporal evolution classification of infective endocarditis

A

Acute and subacute

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7
Q

What are the underlying anatomy classification of infective endocarditis

A

Native valve endocarditis
Prosthetic valve endocarditis

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8
Q

What are the type of risk factor classification of infective endocarditis

A

Native Valve IE
Prosthetic Valve IE
Intravenous drug abuse (IVDA) IE
Nosocomial IE

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9
Q

Infective endocarditis could also be classified based on infecting organism (serves as basis for therapy and prognosis)
True or false

A

True

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10
Q

What are the two pathways for endocarditis

A

Direct pathway (direct infection by virulent organisms (Staph aureus))
Indirect pathway

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11
Q

What is a common mnemonic for the signs and symptoms of endocarditis

A

FROM JANE

Fever, Roth’s spots, Osler’s nodes. Murmur, Janeway lesions, Anemia, Nail hemorrhage (splinter hemorrhages)

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12
Q

What are the non-specific signs of endocarditis

A

Petechiae and splinter hemorrhages

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13
Q

What are the more specific signs of endocarditis

A

Janeway lesions and Osler’s nodes

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14
Q

What are some diagnostic investigations for endocarditis

A

Blood cultures
Echocardiography (TTE)

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15
Q

TTE findings inconclusive of IE
True or false

A

True

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16
Q

What are the ancillary investigations that could be made for IE

A

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

17
Q

What are the two major treatments for IE

A

Antibiotic therapy
Supportive care

18
Q

Talk about the antibiotic treatment of IE

A

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

19
Q

Talk about supportive care treatment for IE

A

Treat urgent complications (e.g., AHF, heart block) and the underlying cause (e.g., removal of infected central lines)

20
Q

What are some complications of IE

A

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

21
Q

Which drug route of administration is preferred in treatment of IE due to erratic absorption of oral agents

A

Parenteral

22
Q

Mention one antibiotic used to treat IE (Monitor for renal effects due to low toxic therapeutic ratio)

A

Aminoglycosides (eg. Gentamicin)

23
Q

What are some indications for surgery in an IE

A

Perivascular invasive disease
Uncontrolled infection despite maximal antimicrobial therapy
Presence of prosthetic valve endocarditis unless late infection
CCF

24
Q

What are the surgical procedures in an IE

A

Valve replacement
Valve repair

25
Q

Prophylaxis is recommended for which types of people

A

People with a:
Prosthetic valve
Previous IE
Cyanotic heart Dx e.g., TOF
RHD
HCM with high gradients
MVP with regurgitation or thickened leaflets

26
Q

What are some oral prevention antibiotic treatment for IE

A

Amoxicillin
Allergic: Clindamycin/Cefadrozil/Erythromycin

27
Q

What are some GU/GI (excluding oesophageal) antibiotic treatments for IE

A

Ampicillin, Gentamicin

Medicine (38 decks)

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