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Clin Med - Cardio Exam #2 > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

Pathologies of endocarditis

A

Prototypic Native Valve Endocarditis (NVE) lesion

Non-bacterial Thrombotic Endocarditis (NBTE)

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2
Q

What are NVE lesions made up of?

A

Mass of platelets, fibrin, microbial microcolonies with scant inflammatory cells

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3
Q

What are NBTE (AKA marantic endocarditis) made up of?

A

uninfected platelet-fibrin thrombus often a nidus for mocrobial adhesion during bacteremia

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4
Q

Explain the Venturi effect

A

NBTE and NVE develop on sides of low-pressure sink just beyond the valve or intraventricular defect or stenosis (they glob on)

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5
Q

T/F Cardiac valves have no dedicated blood supply?

A

T

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6
Q

What effects does the lack of dedicated blood supply have on cardiac valves?

A

Host immune response blunted

Limited access of abx

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7
Q

What cardiac locations are involved in endocarditis?

A

Native/prosthetic valves
Low-pressure side of ventricular septal deffect
Mural endocardium damaged by aberrant jets
Intracardiac devices

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8
Q

What are the 2 older terms still used in some places to classify endocarditis?

A

Subacute Bacterial Endocarditis (SBE)

Acute Bacterial Endocarditis

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9
Q

What is the classification system now preferred for endocarditis?

A

Incubation classification

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10
Q

Incubation less than about_____ is considered short incubation?

A

Six weeks

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11
Q

Inbuation greater than about ______ is considered long incubation?

A

Six weeks

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12
Q

What are the most common current etiologies of endocarditis?

A 
Congenital heard disease
Illicit IV drug use
Degenerative Valve dz
Intracardiac devices
Incidence notability increased in elderly
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13
Q

What percent of cases of NVE are related to healthcare?

A

30-35%

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14
Q

What percentage of endocarditis involves prostehtic valves?

A

16-30%

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15
Q

during what time period is a patient with a valve replacement at greatest risk of endocarditis?

A

6-12 months

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16
Q

What locations on the body can serve as possible soures of infective endocarditis?

A 
Oral cavity
skin
upper respiratory tract
GI
GU
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17
Q

What bacteria may result in endocarditis from oral cavity, skin, and upper respiratory tract?

A

Strep Viridans
Staphlococci
HACEK

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18
Q

What bacteria may result in endocarditis from GI source?

A

Strep gallolyticus
Polyps
colon tumors

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19
Q

What bacteria may result in endocarditis from a GU source?

A

Enterococci

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20
Q

What bacteria may result in endocarditis from a nosocomial source?

A

Staph aureus
CoNS (coag neg staph)
Enterococci

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21
Q

What procedures may result in procedure induced bacteremia?

A 
Endoscopy
Colonoscopy
Barium enema 
Dental Extractions!!!
Transurethral resection of prostate (TURP)
TEE
22
Q

What is the timeline for recognizing a nosocomial infective endocarditis?

A

Exposure within 90 days

23
Q

What valve is most commonly involved in endocarditis in an IV drug user? And what pathogens are most common?

A

Tricuspid-S. aureus, commonly MRSA

24
Q

What percentage of patient’s have negative blood cultures? What is this due to?

A

5-15% come back negative (33-50% of this is due to premature initiation of tx.)

25
Q

Pathogenesis of E-carditis (4)

A
  1. Adhesion molecules recognize MSCRAMMS
  2. Platelet-fibrin vegetations form dense microcolonies of microbes
  3. Organisms deep inside the vegetations are inactive and resistant
  4. Surface organisms continuously shed into the blood stream
26
Q

It is the result of ___________ that causes the symptoms of Endocarditis?

A

Fighting the infection

27
Q

What symptoms result from the pathophys of endocarditis?

A 
Constitutional - cytokine production
Damage to intracardiac structure
Embolization of veg fragments - leading to infection or infarction
Bacteremia
Tissue injury
28
Q

cadiac presentation of E-card?

A

murmurs may not start right away but occur eventually in 85%
CHF (30-40%)-from valvular dysfunction
Intracardiac fistula
MI-dt emboli (2%)

29
Q

Classic presentation seen in 50% of endocarditis pt’s?

A 
Petechiae
subungual (splinter) hemorrhages
Osler nodes
Janeway lesions
Roth spots
30
Q

Define Osler nodes

A

Tender subcutaneous nodules usually distal pads of the digits

31
Q

Define Janeway Lesions

A

Nontender maculae on palms and soles

32
Q

Define Roth spots

A

Retinal hemorrhages w/ small clear centers (rare)

33
Q

CNS diseases that can present with endocarditis?

A

Embolic stroke
Intracerebral hemorrhage
Multiple microabcesses
Seizures

34
Q

What might be seen on CXR in a patient with septic pulmonary emboli?

A

solid and cavitary lesions “circles of crud”

35
Q

What might be seen on EKG secondary to IE?

A

Complete heart block-dissociation

36
Q

Signs of IE?

A 
Splenomegaly
stiff neck
delirium
paralysis, hemi, aphasia
conjunctival hemorrhage
pallor
gallops
rales
cardiac arrhythmia
pericardial rub
pleural friction rub
subacute native valve endocarditis
37
Q

What are the signs of subacute native valve endocarditis?

A 
Low grade fever
anorexia
weight loss
flu-like symptoms
polymyalgia-like syndromes
pleuritic pain
syndromes similar to rheumatic fever
abd. symptoms (ruq pain, vomiting, postprandial distress)
38
Q

What are Most common pathogens of IE?

A

Staph aureus (MC)
CoNS
Gram negative bacilli
**remember the culture can come back negative in many patients

39
Q

What is the test of choice for a pt with endocarditis?

A

ECHO (TEE GOLD!!!)

40
Q

What is true about the risk of doing a TTE on a pt?

A

TEE carries a risk of providing a source for Endocarditis.

41
Q

Duke’s criteria for definite Endocarditis

A

2 major criteria
1 major and 3 minor
or 5 minor

42
Q

Duke’s criteria for possible endocarditis

A

1 major and 1 minor

or 3 minor

43
Q

Major criteria for Dukes:

A

Positive blood culture

Positive Echo

44
Q

Minor criteria for Dukes:

A 
Predisposition
Fever 
Vascular phenomena
Immunologic phenomena (Roth's spots etc.)
Microbiological evidence
45
Q

What are we looking for on Echo?

A

Vegetation

46
Q

Indications for REQUIRED surgical intervention for pt’s with endocarditis?

A

Mod to severe CHF
Partially dehisced unstable prosthetic valve
Persistant bacteremia despite ABX
Lack of effective microbial tx (fungal)
S. Aureus prosthetic valve with intracardiac complication (Fistula)
Relaphse after optimal abx. tx.

47
Q

Once surgery is decided upon what indications require that surgery to be done EMERGENTLY (same day)

A

Acute aortic regurgitation plus pre-closure of mitral valve
Sinus of valsalva abscess ruptured into R heart
Rupture of pericardial sac

48
Q

What patients must have prophylaxis prior to dental procedures?

A

Prosthetic heart valves
Prior endocarditis
Unrepaired cyanotic congenital heart disease
completely repaired congenital heart defects during 6mos after repair
Incompletely repaired congenital heart disease w/ residual defects adjacent to prosthetic material
(valvulopathy developing after cardiac transplantation-this is changing and less necessary)

49
Q

What is the standard oral regiment of abx prophylaxis for pt’s who require it prior to dental procedures?

A

Amoxicillin: 2 g PO 1 h before procedure

50
Q

If left untreated what is the mortality of IE?

A

14.5%

51
Q

What increases the mortality rate for IE?

A 
Increased age
Involvement of Aortic Valve
CHF
CNS complications
Underlying chronic medical conditions e.g. DM
Rates vary dependent upon microbe

Clin Med - Cardio Exam #2 (12 decks)

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