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Clin Med II MHM - Cardio 2 > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

What is the typical Native Valve Endocarditis (NVE) lesion?

A

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

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2
Q

What is the typical Nonbacterial thrombotic endocarditis (NBTE) lesion?

A

Uninfected platelet-fibrin thrombus

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3
Q

What is the Venturi effect?

A

NBTE and NVE develop on the sides of low pressure just beyond the valve or intraventricular defect/stenosis

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4
Q

Why is infective endocarditis so serious/difficult?

A

Cardiac valves have no dedicated blood supply so host immune response is blunted and limits access of abx to valve

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5
Q

What cardiac locations are involved in infective endocarditis?

A
  • Native or prosthetic valves
  • Low pressure side of VSD or valve
  • Mural endocardium
  • Intracardiac devices
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6
Q

What is infective endarteritis?

A

Analogous process (of endocarditis) in AV shunts, PDA, or coarctation of aorta

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7
Q

What is the “old” way to classify bacterial endocarditis?

A
  • Subacute (low virulence, strep)

- Acute (higher virulence, staph aureus)

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8
Q

What is the newer way to classify bacterial endocarditis?

A
  • Short incubation (less than 6 wks)

- Long incubation (6+ weeks)

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9
Q

What organisms MC cause endocarditis from oral cavity, skin, and UR tract?

A
  • Viridans strep
  • Staphylococci
  • HACEK from oral cavity
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10
Q

What organisms MC cause health care associated NVE?

A

Staph aureus
CoNS
Enterococci

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11
Q

What are the MC procedures inducing bacteremia and the organisms associated?

A
  • Dental (S viridans)
  • Endoscopy (CoNS)
  • Colonoscopy (E coli)
  • Barium enema (Enterococci)
  • TEE (S viridans)
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12
Q

When does nosocomial PVE occur and which organisms?

A
  • Less than 2 months after valve surgery

- Usually S aureus, CoNS

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13
Q

What organisms occur with PVE 12+ months after surgery?

A
  • Similar to community acquired NVE

- CoNS

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14
Q

Where does endocarditis colonize MC in IV drug users?

A

Tricuspid valve

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15
Q

What organism usually causes IV drug endocarditis?

A

S aureus (often methicillin resistant)

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16
Q

How do blood cultures present in infective endocarditis?

A

5-15% cases have negative cultures (many due to prior abx exposure OR fastidious organisms)

17
Q

What is the feature of organisms deep in vegetations of endocarditis?

A

They are metabolically inactive (non-growing) and resistant to antimicrobial agents

18
Q

How do murmurs present in infective endocarditis?

A
  • Absent initially

- Ultimately murmurs present in 85% cases

19
Q

Classic signs of infective endocarditis

A
  • Petechiae
  • Splinter hemorrhages
  • Osler nodes
  • Janeway lesions
  • Roth spots
20
Q

What are Osler nodes?

A
  • Tender SC nodules in between digits

- A/w infective endocarditis

21
Q

What are Janeway lesions?

A
  • Nontender maculae on palms and soles

- A/w infective endocarditis

22
Q

What are Roth spots?

A
  • Retinal hemorrhages with small, clear centers (rare)

- A/w infective endocarditis

23
Q

How is infective endocarditis diagnosed?

A
  • TTE (noninvasive and very specific)

- TEE (sensitivity 90+%)

24
Q

Which type of echo is more sensitive and accurate for PVE diagnosis?

A

TEE

25
Q

What are the diagnostic criteria for infective endocarditis?

A

Duke’s (2 major, 1 major 3 minor, 5 minor)

26
Q

What are major Duke’s criteria?

A
  • Positive blood culture

- Evidence of endocardial involvement

27
Q

What are minor Duke’s criteria?

A
  • Predisposition
  • Fever 100.4+ F
  • Vascular phenom
  • Immunologic phenom
  • Microbio evidence
28
Q

Management of infective endocarditis?

A
  • 3 to 5 sets of blood cultures

- Empiric abx AFTER cultures

29
Q

What type of abx are used to treat NVE?

A

Penicillin G and gentamicin

30
Q

Negative blood cultures for endocarditis at 48-72 hrs?

A

Must repeat 2-3 culture sets

31
Q

What type of abx to treat IV drug endocarditis?

A

Nafcillin and gentamicin

32
Q

How is PVE treated differently than NVE?

A

Abx typically a couple weeks longer in duration

33
Q

Surgery is MC required for what type of endocarditis?

A

PVE

Clin Med II MHM - Cardio 2 (12 decks)

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