Endocarditis

Question 1

What are the non-specific symptoms and signs of endocarditis?

Answer 1

fever 
malaise
night sweats 
weight loss 
anaemia 
slight splenomegaly

Question 2

What are the signs and symptoms pretty specific to endocarditis?

Answer 2

new or changing heart murmurs 
splinter haemorrhages 
Roth spots (retinal haemorrhages)
Janeway lesions (painless and non-tender, Palms and soles)
Osler's nodes (painful nodules on finger pads and toes)

Question 3

What pathological process causes the splinter haemorrhages, oslers odes, roth spots and janeway lesions?

Answer 3

Immune complex deposition in small bood vessels

Question 4

What is the most likely infecting organism of native valve indolent endocarditis?

Answer 4

Streptococcus (most common)

Enterococcus

Question 5

What antibitotic should be used for native valve indolent endocarditis?

Answer 5

Amoxicillin and Gentamicin

Question 6

What bacteria is most likely to cause acute/severe sepsis because of endocarditis of a native valve?

Answer 6

Staph aureus

Question 7

What else could cause native valve acute/severe sepsis from endocaritis?

Answer 7

beta-haemolytic Strep group A or B

Question 8

What should be used for the treatment of native valve acute/severe sepsis from endocaritis?

Answer 8

Flucloxacillin

Question 9

What group of people are most likely to get right sided endocarditis? How does this present? What is the likely infecting organism? Treatment?

Answer 9

IVDU
Pneumonia from metastatic abscesses
Staph aureus
Flucloxacillin

Question 10

If there is endocarditis of a prosthetic valve, what antibiotics are required?

Answer 10

Vancomycin and Gentamicin and Rifampicin

Question 11

What invstigations are required if endocarditis is suspected?

Answer 11

3 sets of blood over 24 hours - before antibiotics to identify organism 
Echo 
Serological test for aypicals 
ESR 
Urine distix - haematuria in most cases

Question 12

If the blood tests show that the endocarditis is being caused by a Streptcoccal infection, which antibiotics are required?

Answer 12

Penicillin and Gentamicin

Question 13

If the blood tests show that the endocarditis is being caused by a Staph aureus infection, which antibiotics are required?

Answer 13

Flucloxacillin

Question 14

If the blood tests show that the endocarditis is being caused by an Enterococcus infection, which antibiotics are required?

Answer 14

Amoxicillin +/- Gentamicin

Question 15

When should valve replacement be considered?

Answer 15

Severe heart failure
Early infection of prosthetic material (60 days)
Worsening renal failure
Extensive damage to the valve