Endocarditis

Question 1

4 bugs typically associated with SBE + 2 if BCX peristently +

Answer 1

staph aureus, strep viridans, bovis enteroccocci, HACEK + staph epi, GN bacilli

Question 2

most common and least common condition predisposing to SBE?

Answer 2

MR- most common

MS- least common

Question 3

what % of prosthetic valve endocarditis has NO vegetations?

Answer 3

30%

Question 4

what causes non-bacterial endocarditis

Answer 4

SLE/Libman-Sacks/APLA syndrome

Question 5

what side of the AV are lambl’s excrescence and papillary fibroelastoma seen?

Answer 5

aortic

Question 6

Diagnosis

Answer 6

Papillary Fibroelastoma

Question 7

what side of AV and MV do vegetations usually form?

Answer 7

Atrial side of MV, LV side of AV (due to mild eddy flow regurgitation)

Question 8

Diagnosis and Rx? (ON BOARD EXAM)

Answer 8

early closure of MV from severe AI (from SBE)- RX = emergent surgery

Question 9

Diagnosis?

Answer 9

Perforated MV leaflet (*clue is to see the PISA off the midline)

Question 10

Diagnosis?

Answer 10

Perforated MV leaflet (*clue is to see the PISA off the midline)

Question 11

perivalvular extenion of infection occurs usually with which valve and which bug?

Answer 11

AV, staph

Question 12

does perivalvular extension of infection increase mortality even if surgical correction performed?

Answer 12

yes

Question 13

Diagnosis?

Answer 13

MAIF Phlegmon with Perivalvular Extension of Infection (PVEI)

Question 14

Diagnosis?

Answer 14

MAIF Mycotic Aneurysm (PeriValvular Extension of Infection)

Question 15

why did this pt have persistent fevers after being treated with abx for SBE?

Answer 15

PeriValvular Extension of Infection (see double density next to AV)

Question 16

which location for vegetation is most likely to embolize?

Answer 16

anterior leaflet of MV

Question 17

if you have high suspcion for endocarditis, but TEE negative- what can you do?

Answer 17

repeat TEE in 5-7 d