Endocarditis Flashcards
Infection on a cardiac valve or endocardial surface within the heart
Infective endocarditis
What causes most cases of infective endocarditis?
Bacterial infection
Fungal infections are less common
What causes endocarditis in 50% of cases?
Underlying valve abnormality that provides a source of turbulent flow - transient bacteremia from procedure or surgery colonizes and leads to infection
What causes normal valve endocarditis?
Bacteremia with virulent organism from an infection i.e. an IV drug user
What bacteria commonly causes endocarditis?
S. aureus
Which types of cardiac surgery do not predispose a patient to endocarditis?
CABG and permanent pacemakers
What surgery is very likely to give a patient endocarditis?
Prosthetic heart valves
What are the portals of entry for the bacteremia that in turn causes endocarditis?
Skin, oral cavity, GI tracts
Commonly from procedures or surgeries
What types of procedures put patients at risk for endocarditis?
Dental work/cleaning/flossing and related procedures
Procedures and surgeries involving upper respiratory, lower GI and GU tracts
The presence of ______ catheters put a patient at a risk for endocarditis
Indwelling
Which organisms are common to cause endocarditis?
S aureus MOST COMMON
Strep viridans
Enterococcus fecalis
Group D strep
HACEK organisms: Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella
If a patient has prosthetic valve endocarditis and is sick within the 1st 2 months, what is the most likely organism?
S aureus
S epidermitis
Gram - organisms
If a patient has prosthetic valve endocarditis becomes sick later on, what are the likely organisms?
Staph or strep
Which valves are the most commonly infected with endocarditis?
Mitral and aortic valve
Mass of platelets, fibrin, colonies of bacteria and a few inflammatory cells
Vegetation
What is the classic valve lesion?
Vegetation
Which valve is more effected in RV endocarditis?
Tricuspid more often than pulmonic
Where is the only setting that RV endocarditis is found? What is the common organism?
Only in setting of IV drug abuse; S aureus
What is the study of choice to diagnose endocarditis?
TEE - Transesophageal echocardiography
What are the clinical findings associated with endocarditis?
- Febrile illness with nonspecific symptoms
- Infectious emboli
- New or changing regurgitant heart murmurs may be present
- Peripheral lesions
- Immunologic lesions
What are the symptoms associated with infectious emboli?
Stroke, flank pain, arthritis, cough/dyspnea, abscesses, organ infarction, abd pain
What are examples of peripheral lesions from micro emboli?
Petechiae and subungal
What are the immunologic lesions you might find on a patient with endocarditis?
Olsers nodes
Janeway lesions
Roth spots
Exudative lesions in the retina
Roth spots
Painless red lesions of palms or soles
Janeway lesions
Painful, raised lesions of fingers/tos
Osler’s nodes
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
Staph aureus
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
Strep viridans, enterococcus
What diagnostic studies do you order if you suspect your patient has endocarditis?
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
What is the pathognomonic finding for endocarditis?
Finding a vegetation on TEE
What are the major duke criteria for diagnosing endocarditis?
2+ BC’s with typical organisms
Abnormal echo or vegetation or similar
new regurgitant murmer
What are the minor duke criteria for diagnosing endocarditis?
Predisposing condition: Valve abnormality or IV drug use
Fever
Vascular phenomenon
Immunologic lesion
+BC not meeting above criterion
Using the Modified duke criteria, what is a DEFINITE diagnosis of endocarditis?
2 major criteria
1 major + 3 minor
5 minor
What will you hear on auscultation of the heart that will be severe due to destruction of valves?
Aortic regurgitation
Mitral regurgitation
Tricuspid regurgitation
What would heart failure result from in a patient with endocarditis?
Left sided valvular regurgitation (AR, MR)
What cerebrovascular damage are your patients at a risk for due to endocarditis?
Stroke from emboli traveling to brain
What are the 3 cases where you should DEFINITELY prescribe abx prophylaxis for a patient undergoing surgery?
- Prosthetic heart valves
- Prior episode of endocarditis
- Unrepaired or completely repaired complex cyanotic congenital heart disease
Why do other valvular lesions (congenital or acquired) not require endocarditis prophylaxis?
Risk of endocarditis out-weighed by risk of side effect or reaction to antibiotic
What should treatment of endocarditis be based on?
Organism identified by blood cultures
