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Clin Med Cardio Exam 2 > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

Infection on a cardiac valve or endocardial surface within the heart

A

Infective endocarditis

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2
Q

What causes most cases of infective endocarditis?

A

Bacterial infection

Fungal infections are less common

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3
Q

What causes endocarditis in 50% of cases?

A

Underlying valve abnormality that provides a source of turbulent flow - transient bacteremia from procedure or surgery colonizes and leads to infection

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4
Q

What causes normal valve endocarditis?

A

Bacteremia with virulent organism from an infection i.e. an IV drug user

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5
Q

What bacteria commonly causes endocarditis?

A

S. aureus

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6
Q

Which types of cardiac surgery do not predispose a patient to endocarditis?

A

CABG and permanent pacemakers

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7
Q

What surgery is very likely to give a patient endocarditis?

A

Prosthetic heart valves

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8
Q

What are the portals of entry for the bacteremia that in turn causes endocarditis?

A

Skin, oral cavity, GI tracts

Commonly from procedures or surgeries

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9
Q

What types of procedures put patients at risk for endocarditis?

A

Dental work/cleaning/flossing and related procedures

Procedures and surgeries involving upper respiratory, lower GI and GU tracts

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10
Q

The presence of ______ catheters put a patient at a risk for endocarditis

A

Indwelling

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11
Q

Which organisms are common to cause endocarditis?

A

S aureus MOST COMMON
Strep viridans
Enterococcus fecalis
Group D strep

HACEK organisms:
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
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12
Q

If a patient has prosthetic valve endocarditis and is sick within the 1st 2 months, what is the most likely organism?

A

S aureus
S epidermitis
Gram - organisms

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13
Q

If a patient has prosthetic valve endocarditis becomes sick later on, what are the likely organisms?

A

Staph or strep

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14
Q

Which valves are the most commonly infected with endocarditis?

A

Mitral and aortic valve

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15
Q

Mass of platelets, fibrin, colonies of bacteria and a few inflammatory cells

A

Vegetation

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16
Q

What is the classic valve lesion?

A

Vegetation

17
Q

Which valve is more effected in RV endocarditis?

A

Tricuspid more often than pulmonic

18
Q

Where is the only setting that RV endocarditis is found? What is the common organism?

A

Only in setting of IV drug abuse; S aureus

19
Q

What is the study of choice to diagnose endocarditis?

A

TEE - Transesophageal echocardiography

20
Q

What are the clinical findings associated with endocarditis?

A
  1. Febrile illness with nonspecific symptoms
  2. Infectious emboli
  3. New or changing regurgitant heart murmurs may be present
  4. Peripheral lesions
  5. Immunologic lesions
21
Q

What are the symptoms associated with infectious emboli?

A

Stroke, flank pain, arthritis, cough/dyspnea, abscesses, organ infarction, abd pain

22
Q

What are examples of peripheral lesions from micro emboli?

A

Petechiae and subungal

23
Q

What are the immunologic lesions you might find on a patient with endocarditis?

A

Olsers nodes
Janeway lesions
Roth spots

24
Q

Exudative lesions in the retina

A

Roth spots

25
Q

Painless red lesions of palms or soles

A

Janeway lesions

26
Q

Painful, raised lesions of fingers/tos

A

Osler’s nodes

27
Q

Which bacteria is likely to cause endocarditis that has an acute course with rapidly progressive, destructive infection

Acute febrile illness, early embolization, valvular destruction, and insufficiency

A

Staph aureus

28
Q

Which bacteria is likely to cause a sub-acute course of endocarditis that lasts for weeks at at time

Systemic and peripheral manifestations predominate with gradual valvular destruction

A

Strep viridans, enterococcus

29
Q

What diagnostic studies do you order if you suspect your patient has endocarditis?

A

Blood cultures: Draw a set of 3 one hour apart from each other before considering abx

CBC: Look for leukocytosis or anemia

UA: Look for hematuria

30
Q

What is the pathognomonic finding for endocarditis?

A

Finding a vegetation on TEE

31
Q

What are the major duke criteria for diagnosing endocarditis?

A

2+ BC’s with typical organisms

Abnormal echo or vegetation or similar

new regurgitant murmer

32
Q

What are the minor duke criteria for diagnosing endocarditis?

A

Predisposing condition: Valve abnormality or IV drug use

Fever

Vascular phenomenon

Immunologic lesion

+BC not meeting above criterion

33
Q

Using the Modified duke criteria, what is a DEFINITE diagnosis of endocarditis?

A

2 major criteria

1 major + 3 minor

5 minor

34
Q

What will you hear on auscultation of the heart that will be severe due to destruction of valves?

A

Aortic regurgitation
Mitral regurgitation
Tricuspid regurgitation

35
Q

What would heart failure result from in a patient with endocarditis?

A

Left sided valvular regurgitation (AR, MR)

36
Q

What cerebrovascular damage are your patients at a risk for due to endocarditis?

A

Stroke from emboli traveling to brain

37
Q

What are the 3 cases where you should DEFINITELY prescribe abx prophylaxis for a patient undergoing surgery?

A
  1. Prosthetic heart valves
  2. Prior episode of endocarditis
  3. Unrepaired or completely repaired complex cyanotic congenital heart disease
38
Q

Why do other valvular lesions (congenital or acquired) not require endocarditis prophylaxis?

A

Risk of endocarditis out-weighed by risk of side effect or reaction to antibiotic

39
Q

What should treatment of endocarditis be based on?

A

Organism identified by blood cultures

Clin Med Cardio Exam 2 (6 decks)

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