Endocarditis

Question 1

Infective Endocarditis (IE )Classified into four groups:

Answer 1

Native Valve IE
Prosthetic Valve IE
Intravenous drug abuse (IVDA) IE
Nosocomial IE

Question 2

Principle causative agents of IE

Answer 2

Streptococci most common: Strep. Viridans (oral)
Enterococci
Staphylococci

Question 3

Infective Endocarditis Gram negative organisms

Answer 3

Pseudomonas aeruginosa most common
HACEK:
Haemophilus sp.
Actinobacillus
Cardiobacterium
Eikenella
Kingella

Question 4

Acute IE

Answer 4

affect normal heart valves
Rapidly destructive
Metastatic foci
Commonly Staph.
If not treated, usually fatal within 6 weeks

Question 5

Subacute IE

Answer 5

affects damaged heart valves
Indolent nature
If not treated, usually fatal by one year

Question 6

Pathophysiology

Answer 6

Turbulent blood flow
Bacteremia
Adherence of the organisms
Eventual invasion

Question 7

Prosthetic Valve Endocarditis (PVE)

Answer 7

Early PVE – within 60 days
Nosocomial (S. epidermidis predominates)
Late PVE – after 60 days
Community (same organisms as NVE)

Question 8

Acute Symptoms…caused by S. Aureus

Answer 8

High grade fever** and chills
SOB
Arthralgias/ myalgias
Abdominal pain (spleenomegally) 
Pleuritic chest pain
Back pain

Question 9

Subacute Symptoms… caused by S. viridans

Answer 9

Low grade fever**
Anorexia
Weight loss
Fatigue
Arthralgias/ myalgias
Abdominal pain (spleen)
N/V

Question 10

Antimicrobial Therapy

Answer 10

Antibiotics are usually administered intravenously for 4-6 weeks.
The drug of choice for most cases of viridians streptococcal endocarditis is penicillin

Question 11

High risk lesions- treat prophylactically

Answer 11

Prosthetic valves
Prior IE
Cyanotic congenital heart disease
Surgical systemic-pulmonary shunts