Endocarditis Flashcards
when do you assume it is endocarditis until proven otherwise
fever + new murmur
what % of endocarditis occur on normal valves
50%
what is the main cause of IE on normal valves
S aureus
risk factors of IE on normal valves
dermatitis,IVI, renal failure, DM, organ transplantation, post op wounds
what course does endocarditis run on normal and abnormal valves (acute or subacute)
normal- acute presents acute heart failure and emboli. abnormal- subacute
risk factors of IE on abnormal valves
mitral or aortic valve disease; tricuspid valves in IV users; coarctation; patent ductus arteriosus ; prosthetic valves; VSD
common cause IE (bacteria)
strep viridans (>35%)
other bacterial causes IE
enterococci; staph aureus/epidermidis; diptheroids; microaerophilic streps
causes IE (fungi)
candida; aspergillus; histoplasma
other causes IE
SLE; malignancy
signs- septic
fever, rigors, night sweats, malaise, weight loss, anaemia, splenomegaly, clubbing.
signs- cardiac lesions
any new murmur, or changing pre existing murmur. valve destruction, obstruction or severe regurg. aortic root abscess- prolongation PR interval- complete AV block
what is a common cause of death in IE
LVF
signs- immune complex deposition
vasculitis, glomerulonephritis, acute renal failure. Roth spots, splinter haemorrhages, Oslers nodes
signs- embolic
emboli may cause abscesses in organs, Janeways lesions.
what criteria is used in diagnosis
Dukes
what blood tests are needed to diagnose
cultures- 3 at different times, dif sites at peak of fever. bloods- normochromic, normocytic anaemia; neutrophilia; high ESR/CRP. U&E, Mg2+, LFT.
what is urinalysis used for in IE
microscopic haematuria
what will the CXR, ECG and echo show
CXR- cardiomegaly; ECG- prolonged PR interval; echo- vegetations, mitral lesions, aortic root abscess
when would you consider surgery
heart failure, repeated emboli, valvular obstruction, fungal endo, persistent bacteraemia, myocardial abscess, unstable infected prosthetic valve
what are Janeways lesions
non tender erythematous, haemorraghic, or pustular spots on palms or soles.
what are oslers nodes
tender and painful, raised, red lesions/spots on fingers or toes
antibiotic therapy - blind
amoxicillin, gentamicin, vancomycin
antibiotic therapy-staphs
flucloxacillin (+rifampicin +gentamicin for prosthetic valve)
antibiotic therapy-streps
benzylpenicillin, if not as sensitive give + gentamicin
antibiotic therapy- enterococci
amoxicillin + gentamicin
antibiotic therapy- HACEK
amoxicillin 4 weeks, + gentamicin 2 wks