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Boards: Cardiovascular > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

Explain the steps from a mechanical endocardial injury to baterial endocarditis

A

mechanical damage - release of tissue factor, thromboplastin, extracellular matrix proteins –> clot formation
fibrinogen binds to bacteria

fibronectin causes endothelial cell internalization of bacteria

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2
Q

How do bacteria causing endocarditis escape the immune system?

A

internalization

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3
Q

What immune-mediated diseases are associated with endocarditis and how do they develop?

A

Polyarthritis
glomerulonephritis

endocarditis causes antibody complexes and complement complex depositions

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4
Q

What location of endocarditis is more likely to cause thromboembolism?

A

mitral

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5
Q

Thromboembolic disease from endocarditis most commonly leads to infarction in what organs?

A

kidneys and spleen

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6
Q

What is the most common presenting complaint of endocarditis?

A

lameness

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7
Q

What structural heart disease predisposes to infectious endocarditis?

A

subaortic stenosis

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8
Q

List common causes of bacteriemia that have shown to cause endocarditis

A

UTIs
indwelling urinary catheters
dyskospondylitis
pneumonia
pyoderma
periodontal disease

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9
Q

What is the recommendation for prophylactic Abx therapy for dental procedures?

A

only if aortic stenosis or other congenital heart disease present

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10
Q

What are the most common bacterial causes for endocarditis

A

Staph
Strep
E.Coli

more now: Bartonella

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11
Q

What valve is usually affected by Bartonella endocarditis?

A

aortic

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12
Q

What type of murmur and pulse pressure changes may be noted with aortic endocarditis?

A

diastolic murmur form aortic insufficiency

increased pulse pressure –> bounding pulses

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13
Q

List the 4 types of arrhythmias reported with endocarditis in order of frequency. Which valve affected is more likely to cause arrhythmias?

A

Ventricular tachyarrhythmias
SVTs
AV block
Afib

Aortic more prone
Overall common in IE —> 40-70%

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14
Q

What changes are typically seen on a coagulation profile in a dog with endocarditis?

A

increased FDP and D-dimer
hyperfibrinogenemia
thrombocytopenia

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15
Q

What is the pathognomonic echo lesion for endocarditis?

A

vegetative oscillating lesion

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16
Q

How should you adjust your blood culture sampling if the patient is already on Abx?

A

get culture samples at time of trough

17
Q

What are the 4 Major criteria of the Modified Duke Criteria?

A
  • vegetative lesion/erosive lesion/abscess
  • positive blood culture (2 or more positive, or 3 or more of common skin contaminants)
  • new valvular insufficiency
  • more than mild aortic insufficiency in abscence of subaortic stenosis
18
Q

What are the 7 Minor criteria of the Modified Duke Criteria?

A
  • fever
  • subaortic stenosis
  • blood culture not meeting major criteria
  • Bartonella serology > 1:1024
  • IMPA or glomerulonephritis
  • thromboembolic disease
  • large dog > 15kg
19
Q

What defines a Definitve Diagnosis for the Modified Duke Criteria?

A
  • histopath
  • 2 major
  • one major + 2 minor
20
Q

What defines a Possible Diagnosis for the Modified Duke Criteria?

A
  • 1 major + 1 minor
  • three minor
21
Q

What defines a Unlikely Diagnosis for the Modified Duke Criteria?

A
  • resolution in less than 4 days
  • other diagnosis was made
  • no evidence at necropsy
22
Q

What is the recommended empiric Abx therapy until the culture is back, or if the culture is negative and bacterial infection is suspected?

A

Amikacin + ampicillin/sulbactam if kidney function okay

23
Q

What is the recommended treatment length for IV and oral antimicrobial therapy in endocarditis?

A

1-2 weeks IV, 6-8 week oral

24
Q

When rechecking a patient with infectious endocarditis after 1 week of Abx therapy, the vegetative lesions has not improved. How do you adjust the Abx theray?

A

broaden spectrum

25
Q

What is the current recommendation for antithrombotic therapy in endocarditis?

A

not recommended

26
Q

What are risk factors for early cardiovascular death?

A
  • thromboembolic disease
  • azotemia
  • CHF

Boards: Cardiovascular (19 decks)

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