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Cardio Module > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

What are the two etiologies of endocarditis

A
  1. infective (microbial) –> destroys the valve tissue and you get thrombosis and microbes within the vegetation
  2. non-infective (non microbial)
    • verrucous (rheumatic fever)
      - atypical (SLE)
      - thrombotic-like (marantic)
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2
Q

Contrast subacute and acute in :

  • course
  • organism
  • valve integrity
  • symptoms
  • valve destruction
A
  • weeks-months v days
  • S. viridans (non virulent) v S. aureus (virulent)
  • prior damage to valve v a prior normal valve
  • insidious (malaise, fever low-grarde v abrupt (fever, chills, ill)
  • mild-moderate v severe
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3
Q

Give the step by step patho of infective endocarditis

A
  1. Form non-bacterial thrombotic endocarditis, causing turbulent flow and endothelial damage (resulting in deposits of platelet-fibrin thrombi)
  2. transient bacteremia results due to mucosal trauma and bacteria released
  3. bacteria adhere via adhesins/agglutiinins, localizing to the high flow, low pressure side
  4. vegetation forms here (fibrin, platelets, red cells, bacteria)
  5. metabolically inactive bacteria can proliferate at these vegetations states
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4
Q

What further conditions can these vegetations bring?

A
  1. sustained bacteremia (fever/fatigue)
  2. direct valve damage (MR/AR/TR, and eventually heart failure)
  3. emboli
  4. circulating immune complexes
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5
Q

What are the two most common symptoms?

A

fever, then chills and sweats

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6
Q

name most common signs of endocarditis

A

fever

heart murmur

new/worsened murmur

embolic phenomoneon

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7
Q

if a murmur is new/present what type is it typically?

A
  • regurgitant murmur
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8
Q

3 cardiac manifestations of endocarditis

A
  1. murmurs
  2. myocardial abscess formation at the septum/valve ring
  3. mycotic aneurysm (BACTERIAL) via peripheral arterial invasion
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9
Q

What are the three main non-cardiac areas of body affected by Endocarditis

A
  1. cutaneous
  2. ophthalmic
  3. cerebral
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10
Q

What are the three main cutaneious manifestations and what are tehy?

A
  1. osler nodes (PAINFUL) via deposits of immune complexes
  2. janeway lesions (PAINLESS) via septic emboli
  3. splinter hemorrhages (red-brown streaks on fingernails/toenails
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11
Q

2 main ophthalmic manifestations

A
  1. petechiae (red spots on conjuctiva because of hemorrhage via broken capillaries
  2. roth spots (retinal lessions)
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12
Q

Main cerebral manifestation… what condition puts endocarditis on the differential

A
  • mycotic aneurysm

- stroke

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13
Q

WHAT ARE LAB MANIFESTATIONS of endocarditis

A
  1. anemia (via hemolysis during chronic disease)
  2. leukocytosis (not as high elevated WB, but still elevated)
  3. elevated ESR/CRP
  4. proteinuria (if kidney is affected)
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14
Q

how to diagnose endocarditis

if positive, what does it tell yoU?

A
  1. blood cultures

3 sets in first 24 hours (more if you’ve taken antibiotics given in 2 weeks

  • hold in lab for >21 days for completeness

if positive, only tells you for sure you have bacteremia

  1. use echocardiography to identify vegetations, characterize them, and identify complications
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15
Q

What is the duke major criteria for endocarditis

A
  1. positive blood cultures

2. endocardial involvement seen via regurgitant murmur or echo showing vegetation

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16
Q

what echo method should be used to view vegetation

A

TEE

17
Q

Name 3 complications of IE

A
  1. direct valve destruction
  2. local extenstion
  3. peripiheral embolization
18
Q

Name 4 sources of bacteremia

A
  1. Oral cavity/skin/Upper respiratory (S. viridans, staphylococci, groiup b strep, Hacek group)
  2. GI tract (S. bovis)
  3. Urinary tract (enterococci)
  4. Health care setting (foleys for sure): S. aureus, enterococci
19
Q

what is the HACEK group

A

Haemophilus species
Actinobacillius actinomycetemcomitans

Cardiobacterium hominis

Eikenella corrodens

Kingella kingae

20
Q

What endocarditis does IV drug users do?

A

Tricuspid valve endocarditis (S aureus)

21
Q

What microorganism causes endocarditis in prosthetic valves

A
  • Staph epidermidis
22
Q

What microorganism would cause endo in GI disease

A

S. bovis

23
Q

What microorganism would cause endo in young women/old men

A

S. enterococcus

24
Q

What microorganism would cause endo in those with abnormal valves?

A
  • S. viridans
25
Q

Classically, acute endocarditis in IV drug users would be due to ______ affecting the _____ valve

A
  • S. aureus

- tricuspid

26
Q

why in general are left sided endocarditis cases seen more often

A
  • this is the high pressure side, which is where microorganisms tend to localize in these areas
27
Q

For prosthetic heart valves..

what microorganism are you worried about <12 months after? > 12 months after? in gneral, what is the time period of your highest risk?

What valve is more likely to get endo in this case, aortic or mitral?

A
  • S. epidermis
  • coag neg staph

<6 months is worst risk

SAME incidence rate between aortic and mitral (both left sided)

28
Q

What are etiologic factors of culture negative endocarditis

A
  1. previous antibiotic therapy that causes elusion of blood cultures
  2. fastidious, slow growing orgnaisms
  3. shitty microbiological techniques (culture)
29
Q

What are agents of culture negative endo

prognosis if still febril > 1 wk

A
  • bartonella, C burnettii

50 percent survival

30
Q

What children are most susceptible and have high mortality of endo

A
  • premies w/ s. aureus and cyanotic congenital lesions (tetrology)
31
Q

What is NBTE endocaridtis

what part of heart does and types (mechanical v prosthetic) does it affect

what physiological state is it associated with?

A

marantic

  • sterile, non-destructive vegetations
  • usually native valves (neither prosthetic nor mechanical)
  • hypercoagulable state
32
Q

Who is at highest risk of endocarditis? lowest/absent?

A

Highest:

  • CHD
  • prior CV surgery with device insertion
  • IVDA/eldelrly/immnosuppressed
  • prior episoode of endo
  • transplants with valvulopathy

Low: ASD (no pressure gradient anymore)

33
Q

what are 4 principles of therapy

A
  1. bactericidal agents
  2. IV administration
  3. long duration
  4. prepare for relapse
34
Q

Name 5 surgical indications

A
  1. refractory HF (severe valve dysfunciton)
  2. > 1 serious embolic episode
    s
  3. uncontrolled infection (persistent fever/bacteremia)
  4. lack of effective abx
  5. MOST prosthetic valves (can’t clear infection with just medicine because of access)

Cardio Module (25 decks)

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