Endocarditis

Question 1

Most common site for endocarditis?

Answer 1

Valves

Question 2

Most common bug causing endocarditis?

Answer 2

Streptococci
60% of cases
Then enterococci and staph

Question 3

How do these bugs attach to the endocardium?

Answer 3

Adhesins

Question 4

Most common gram- bug?

Answer 4

Pseudomonas Aeruginosa

Question 5

Acute endocarditis

Answer 5

Affects normal heart valves
Rapidly deconstructive
Metastatic foci
Commonly staph
Usually fatal within 6 weeks if not tx

Question 6

Subacute endocarditis

Answer 6

Often affects damaged heart valves
Indolent nature
If not treated, fatal in one year

Question 7

IE Patho

Answer 7

Turbulent blood flow
Bacteremia
Adherence
Eventual invasion

Question 8

Local destructive effects

Answer 8

Valvular distortion
Chordal rupture
Paravalvular abscess
Conduction abnormalities
Purulent pericarditis

Question 9

Embolization in IE

Answer 9

Clinically evident in 11 - 43%

Actually evident in 45 - 65%

Question 10

Relative risk for NVE in patients with MVP

Answer 10

3.5 - 8.2%
Higher if murmor is detected
More common in men

Question 11

Cause of IE in pediatrics

Answer 11

Underlying congenital abnormality
Neonates: S Aureus
Older kids: strep and staph

Question 12

IVDAIE

Answer 12

Risk is 2 - 5% per year per pt
Tendency to be R sided, favoring the tricuspid
Underlying valve is usually normal
Generally staph A.

Question 13

Prosthetic valve endocarditis (PVE)

Answer 13

10 - 30% of all cases
Early: generally nosocomial (S. Epidermis)
Late: Comminuty

Question 14

Prosthetic Valve Endocarditis (PVE)

Answer 14

Rothia Mucilaginosa
Normal mouth bacteria
S. Salivarius

Question 15

S/S of acute IE

Answer 15

High grade fever
SOB/ pleuritic chest pain
Arthralgias, myalgias
Abd pain
Back pain

Question 16

S/S of subacute IE

Answer 16

Low grade fever
Anorexia
Weight loss
Fatigue
Arthralgias, myalgias
Abd pain, N/V

Question 17

Specific signs of IE

Answer 17

Oslers nodes
Janeway lesions
Roth spots

Question 18

Systemic Clinical features of IE

Answer 18

Systemic Emboli
Neurological signs
CHF
Renal insufficiency

Question 19

Blood cultures for IE

Answer 19

Obtain 3 different samples from 3 separate sites

Question 20

Which echo should be done for IE?

Answer 20

Transthoracic Echo

Question 21

T of F: Females have a better prognosis for IE.

Answer 21

False, they have a worse prognosis.

Yay for schlongs!

Question 22

Drug of choice for strep viridians?

Answer 22

Penicillin IV

Question 23

Standard prophylaxis for IE before surgery.

Answer 23

Amoxacillin, 2g orally 1 hr befor eprocedure

Clindamycin if allergic

Question 24

Prophylaxis for high-risk GI/GU procedures?

Answer 24

Amp and Gent