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SBOMs > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

What is endocarditis until proven otherwise?

A

Fever and new murmur

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2
Q

Why is endocarditis deadly?

A

Can cause end organ failure from emboli (heart, respiratory and kidney)

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3
Q

Risk factors of endocarditis?

A 
Previous rheumatic disease
Age related valvular degeneration
Prosthetic valve
IV drug use
Congenital heart disease
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4
Q

Why is the normal immune response impaired?

A

Valve cusps are avascular

Protective layer of fibrin and platelets around vegetation means antibiotics can’t reach infection

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5
Q

What can lead to organisms entering the blood stream?

A

Poor dental hygiene
IV drug use
Soft tissue infection
Pacemakers/cardiac surgery

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6
Q

Name 10 acute signs and symptoms of endocarditis

A 
Fever
New murmur
Cardiac/renal failure
Rigors and night sweats
Splinter haemorrhages
Roth spots on retina
Cerebral embolic events (stroke/TIA)
Malaise
Breathlessness
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7
Q

Name 5 subacute signs and symptoms of endocarditis

A 
Splenomegaly
Clubbing
Purpura
Osler's nodes (tender and 3D on fingers)
Janeway lesions (flat painless)
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8
Q

How is endocarditis diagnosed?

A 
Positive blood culture of typical pathogen
Vegetation/abscess seen on echo
New valvular regurgitation
\+ predisposing risk factors
\+fever>38º
Immunologic/embolic signs/events
Serology/abnormal culture
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9
Q

Treatment of endocarditis?

A 
IV antibiotics (liase with microbiology)
Monitor (kidneys, treatment, PR interval)
Surgeons? Intensive care?
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10
Q

Complications of endocarditis?

A 
Heart failure
Aortic root abscess
AV block
MI
Stroke/renal/splenic infarcts
Retinal artery occlusion
Acute limb ischaemia
PE
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11
Q

Instead of emboli, what could cause the osler’s nodes, roth spots, splinter haemorrhages?

A

Immune complex formation

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12
Q

Acute renal failure occurs because:

A 
Immune complex and vasculitic glomerulonephritis
Septic emboli-> infarction
Heart failure-> haemodynamic impairment
Antibiotic toxicity
CT imaging nephrotoxicity
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13
Q

What is an echocardiogram?

A

High frequency sound waves to generate images of the heart and detect blood flow within the cardiac chambers and blood vessels

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14
Q

When would an echo be ordered

A 
To investigate cardiac symptoms (breathlessness, chest pain, palpitations)
Investigate signs (murmur, raised JVP, peripheral oedema)
Investigate unwell patient (MI, heart failure, rule out PE, aortic dissection, endocarditis)
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15
Q

What is the colour on an echo?

A

Colour doppler to assess flow

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16
Q

What % of endocarditis is culture negative?

A

30%

17
Q

What would you do if the culture came back negative?

A

If pt on antibiotics, consider stopping them and repeating 3 sets of blood cultures
May have to off them for 7-10 days for +ve blood cultures

18
Q

What are other causes of endocarditis not usually picked up by blood culture?

A 
HACEK organisms
Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella
19
Q

How would you treat HACEK endocarditis?

A

Ceftriaxone or ciprofloxacin

20
Q

What would serology be looking for?

A 
Intracellular organisms:
Bartonella spp
Coxiella burnetii
Tropheryma whipplei
Mycoplasma spp
Legionalla spp
Brucella spp
21
Q

What are the most common organisms?

A 
Staph aureus
Streptococcus (coagulase negative/viridans/bovic/other)
Enterococcus
HACEK
Fungi/yeast
Polymicrobial
Culture negative
22
Q

Treatment for chronic endocarditis?

A

IV amoxicillin

23
Q

Treatment for sever sepsis endocarditis?

A

Vancomycin + gentamicin

24
Q

Indication for endocarditis surgery?

A

Heart failure
Uncontrolled infection
Prevention of embolism

25
Q

Heart failure in endocarditis is caused by what?

A

Mitral chordal rupture/leaflet formation
Vegetation obstructing closure
Intracardiac fistula

26
Q

What indicates uncontrolled infection in endocarditis and is an indication for surgery?

A

Abscess, pseudoaneurysm, fistulae

27
Q

What does the surgical treatment of endocarditis aim to do?

A

Debride infected tissue
Close cardiac defects
Repair valves/replace valves
Insert an aortic homograft in aortic root abscesses

28
Q

What is the mortality of surgery for endocarditis in native valves versus prosthetic valves

A

5-10% native

10-20% prosthetic

SBOMs (18 decks)

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