endocarditis

Question 1

What is endocarditis?

Answer 1

• infection and subsequent inflammation and necrosis of endocardium
• infection often spreads to adjacent myocardium

Question 2

What is the most common cause of endocarditis in most animals?

Answer 2

usually bacterial

Question 3

What are the most common bacteria in endocarditis in dogs?

Answer 3

• staph
• e. coli
• strep

Question 4

What is the pathogenesis of endocarditis?

Answer 4

• formation of vegetation resulting in a large, proliferative mass
• pre-existing endocardial damage often necessary
• direct endocardial damage from vegetations

Question 5

Which statement on endocarditis in the dog is correct?
A. Bacteria directly invade valvular tissue
B. Platelets bind following bacterial colonization
C. Endothelial injury is the initial step leading to endocarditis
D. Bacteremia results in endothelial injury
E. All statements are correct

Answer 5

C. Endothelial injury is the initial step leading to endocarditis

Question 6

Which valves are most affected in small animals with endocarditis?

Answer 6

mitral > aortic

Question 7

Which valves are most affected in equine endocarditis?

Answer 7

aortic > mitral

Question 8

Which valve is most affected in cattle with endocarditis?

Answer 8

tricuspid

Question 9

What can cause the vegetations that are seen in endocarditis?

Answer 9

• septic emboli

- continuous formation of circulating immune complexes secondary to immune-mediated disease

Question 10

What predisposing events can cause endocarditis?

Answer 10

• surgery
• septic focus (ex: abscess)
• ruminitis
• thrombophlebitis
• immunosuppressive therapy

Question 11

What predisposing CV disease can cause endocarditis in dogs?

Answer 11

subaortic stenosis

Question 12

Which animal is predisposed to endocarditis?
A. Heifer out on grass pasture
B. Poodle with severe mitral regurgitation
C. Cat with HCM
D. Horse with an infected incision site
E. Bichon frise with teeth falling out

Answer 12

D. Horse with infected incision site

Question 13

What are the clinical signs of endocarditis?

Answer 13

• fever of unknown origin
• anorexia
• lethargy
• lameness
• CHF
• collapse/syncope
• signs of organ infarction
• signs related to immune-complex diseases

(i.e. diverse and vague)

Question 14

What are some common PE findings of endocarditis?

Answer 14

• murmur
• bounding pulses
• arrhythmias
• injected MM
• lameness

Question 15

Which abnormality is consistent with endocarditis?
A. Thrombocytopenia
B. Hypoglobulinemia
C. Regenerative anemia
D. Eosinophilia

Answer 15

A. Thrombocytopenia

Question 16

Which statement is correct?
A. The vegetation of endocarditis appears very different from DVD
B. The vegetation tends to grow on the higher pressure side of the valve
C. The vegetation may result in valvular stenosis
D. Valvular insufficiency is an infrequent finding with endocarditis

Answer 16

C. The vegetation may result in valvular stenosis

Question 17

What test is critical for confirming endocarditis?

Answer 17

blood culture

need 3-4 samples, at least one hour apart, from two different sites

Question 18

What are the major criteria for diagnosing endocarditis?

Answer 18

• positive blood cultures (2) from typical bug
• positive blood cultures (3) from atypical bug
• evidence of endocardial involvement

Question 19

What is involved in a definitive diagnosis of endocarditis?

Answer 19

• 2 major bugs
• 1 major and 3 minor
• or 5 minor

Question 20

What is difficult to culture from blood in endocarditis?

Answer 20

bartonella, a fastidious intracellular bacterium from ticks and fleas

Question 21

What should antimicrobial therapy consist of for endocarditis?

Answer 21

• bactericidal
• higher serum concentration of drug
• prolonged therapeutic course

Question 22

How do you treat bartonella sp. in endocarditis?

Answer 22

doxycycline or azithromycin

Question 23

What is the prognosis for endocarditis?

Answer 23

guarded to grave because valvular damage is permanent, there may be systemic disease, and re-infection can occur

Question 24

When are prophylactic antibiotics recommended for preventing endocarditis?

Answer 24

• subaortic stenosis
• intracardiac implants
• catheterization procedure

(not recommended for DVD)