Endocarditis

Question 1

Osler node

Answer 1

OUCH - painful
@ FINGERS & TOES
Immune complexes - nothing will grow on culture

Question 2

Janeway lesion

Answer 2

Non-tender, macular or nodular
@ PALMS & FOOT SOLES
Grow bacteria is cultured b/c are SEPTIC emboli

Question 3

What would elevated urinalysis with RBC casts indicate?

Answer 3

Infectious process of the kidneys

Glomerular nephritis

Question 4

Explain the pathogenesis of endocarditis

Answer 4

Damaged valve
Turbulent blood flow
Endothelial injury
Platelet+fibrin deposition
Bacteria colonization
Transient bacteremia 
Infected thrombus 
Biofilm forms - ineffective clearance of infection

Question 5

Which bug are you thinking of for endocarditis with normal valves?

Answer 5

S.aureus
ACUTE onset
Aka why you’ll get endocarditis in IV drug users

Question 6

Which 3 bugs are you thinking of for endocarditis with damaged valves?

Answer 6

Viridans strep
Enterococci
Staph
Strep bovis (if h/o colorectal cancer)

Question 7

Risk factors for endocarditis

Answer 7

H/o rheumatic fever
valvular heart disease
IV drug use
immunosuppression
prosthetic heart valve
atrial/ventricular septal defect

Question 8

FROM JANE mnemonic for endocarditis symptoms

Answer 8

Fever
Roth spots = eye microemboli
Oslers node
Murmer
Janeway lesions
Anemia
Nail hemorrhages (splinter hemorrhages)
Emboli (may lead to stroke w/ neuro symptoms or glomerulonephritis)

Question 9

Diagnostic tests for endocarditis

Answer 9

Blood cultures (looking for multiple cultures positive for the same bug)
Echocardiographs - vegetations
CXR - septic emboli indicates Rheart endocarditis

Question 10

Drugs to treat viridans strep endocarditis. Include cons of each.

Answer 10

CIDAL DRUGS
Penicillin - 4 wks 
- Con = short 1/2 life 
Ceftriaxone - 4 wks
- Con = broader
Penicillin + gentamicin - 2 wks 
- Con = increased toxicity 
Vanco if penicillin allergy

Question 11

How can S.aureus endocarditis be distinguished from simple bacteremia?

Answer 11

Emobli

Question 12

Drugs to treat s.aureus endocarditis

Answer 12

Until you get labs back:
- Vanco or dapto
MSSA:
- Nafcillin or cefazolin - 6 wks
MRSA:
- Continue vanco or dapto choice

Question 13

L sided endocarditis

• High or low virulence organisms
• High or low mortality

Answer 13

Low virulence organisms

Higher mortality - complications go systemic

Question 14

R sided endocarditis

• High or low virulence organisms
• High or low mortality

Answer 14

High virulence organisms

Lower mortality - caught by lungs