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Year 1 > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

What is bacteriemia?

A

Bacteraemia is presence of bacteria in the blood - blood is usually sterile, so bacteraemia could result in sepsis.

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2
Q

What is endocarditis?

A

Inflammation of the inner lining of valves of the heart (usually mitral and aortic), the endocardium.

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3
Q

What is the epidemiology of infective endocarditis?

A

Usually older than 50
25% mortality
Maybe acute or subacute

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4
Q

What are the risk factors for developing endocarditis?

A

Heart valve abnormalities such as congenital herat disease, calcification of valves (elderly patients)
Having prosthetic valves
Being an IV drug user or using IV lines

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5
Q

Describe the pathogenesis of infective endocarditis

A

First step is damage to the heart valve.
This results in turbulent blood flow over the endothelium, leads to platelet and fibrin deposition.
Transient bacteraemia -> organisms settling into the valve set up. They live there creating a microbial vegetation.

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6
Q

Consequences of infective endocarditis?

A

Microbial vegetations can break off, becoming lodged in a capillary bed.
This can lead to abscess formation or haemorrhage - FATAL!

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7
Q

What are the common causative organisms of endocarditis?

A

Staph aureous - most common. From the mouth and causes bacteaemia through dental treatment.
Viridans are almost as common as staph A. They also live in the mouth.

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8
Q

What are some atypical gram negative organisms that cause endocarditis?

A 
HACEK
Haemophilus
Agreggibacter
Cardiobacterium
Eikenella
Kingella
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9
Q

What is the major criteria for diagnosing infective endocarditis?

A

1) Two seperate positive blood cultures for microorganisms typical for IE.
2) Echocardiographic evidence of endocardial involvement
3) New valvular regurgitation

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10
Q

What is the minor criteria for diagnosing infective endocarditis?

A

Pyrexial
Predisposition (i.e. heart condition or IV use)
Vascular evidence such as major emboli (from vegetation, haemorrhage, janeway lesions, oslers nodes
Some sort of microbio evidence - positive blood culture doesn’t meet major criteria, or positive serology consistent with IE typical organisms

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11
Q

What is the significance of Staphylococcus Epidermidis in blood cultures?

A

Could be contaminant from skin (when taking sample!)
Could be from IV drug users or prosthetic valves/joints
Take another set of blood culture to confirm!!!

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12
Q

What is the appearance of staph aureous?

A

Clusters of cocci, gram positive (stain purple)

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13
Q

What tests should be performed to determine strain/microorganism?

A

Use media to create colony

Use MALDI TOF profile spectrum to identify species.

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14
Q

What is the clinical presentation of acute IE?

A

Overwhelming sepsis and cardiac failure (heart unable to pump blood to match body’s needs)

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15
Q

What are the symptoms of subacute IE?

A 
Fever
Malaise
Weight loss
Tiredness
Breathlessnes
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16
Q

What are the signs of subacute IE?

A 
Fever
New or changing heart murmur
Finger clubbing
Splenomegaly
Roth spots, Janeway lesions, Oslers nodes, Splinter haemorrhages
Microscopic blood in urine (haematuria)
17
Q

What is the appearance of Streptococci viridans?

A

Alpha hemolytic on blood agar, gram positive stain - purple

18
Q

What are the different types of prosthetic valve endocarditis?

A

Early - infected before insertion, usually due to Staph aureus or Staph epidermidis. Presents within 60 days

Late- Due to coincidental bactereamia (turbulent blood flow due to unnatural valve)

19
Q

Treatment for patients with prosthetic valves and infective endocarditis?

A 
Vancomycin IV IMMEDIATE
Gentamicin IV IMMEDIATE
Rifamicin PO DELAYED (3-5 days)
Often valve replacement required. 
Treat with VGR!
20
Q

What is the microrganism usually found in people who inject drugs?

A

Usually staphylococcus aureus

Found in right side of heart, likely to find pulmonary septic emboli

21
Q

What is the treatment for people who inject drugs?

A

Flucloxacillin IV - Staph aureus is gram positive

22
Q

What is the treatment for native valve endocarditis?

A

Amoxicillin and gentamicin IV

endocarditis makes me go AG!

23
Q

What is the treatment for staphyloccus epidermis infection?

A 
Vancomycin IV IMMEDIATE
Gentamicin IV IMMEDIATE
Rifamicin PO DELAYED (3-5 days)
Often valve replacement required. 
Treat with VGR!
24
Q

What is the treatment for staphylococcus aureus?

A

Fluclxacillin IV

25
Q

Monitoring guidelines for IE..

A

IV antibiotics for 4-6 weeks
Monitor cardiac function, temperature and CRP
If failing antibiotic therapy consider referral for surgery early! Espiecally if there is high embolic risk or high heart failure risk!

26
Q

What is myocarditis?

A

Inflammation of heart muscle. More common in young people, cause of sudden death.

27
Q

What are the symptoms of myocarditis?

A

Fever
Chest pain
shortness of breath
Palpitations

28
Q

What are the signs of myocarditis

A

Arrythmia

Cardiac failure

29
Q

How is myocarditis diagnosed?

A

Sample from throat swab and stools

PCR confirms viral presence

30
Q

What is the most likely causative microorganism family for myocarditis?

A

Enteroviruses. Results in apoptosis and necrosis of muscle tissue. Prognosis is either resolving infection or ongoing autoimmune response - this leads to dilated cardiomyopathy.

31
Q

What is pericarditis?

A

Inflammation of pericardium (visceral serous and fibrous.) Often occurs with myocarditis.

32
Q

What is the cause of pericarditis?

A

Usually viral

Bacterial less common but can occur following cardiothoracic surgery. RARELY secondary to endocarditis or pneumonia.

33
Q

What is the treatment for viral aetiologies?

A

Viral aetiology - peri and myocarditis

Supportive treatment

34
Q

What is the treatment for bacterial pericarditis?

A

Antibiotics and drainage

Year 1 (15 decks)

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