Endocarditis Flashcards
what is it
infection of endothelium of valves
damaged valves product turbulent flow over irritated endothelium, causing bacteria to settle producing vegetation of valve
what are acute symptoms
overwhelming sepsis and cardiac failure
what are subacute symptoms
fever malaise weight loss tiredness breathlessness
what is signs
fever
roth spots (retinal haemorrhages with white centres)
oslers nodes (red-purple lumps on fingers and toes)
murmur
janeway lesions (non tender, often haemorrhagic and occur on palms and aoles including base of thumb and little finger)
anaemia
splinter haemorrhages
emboli
what is the predisposing factors
rheumatic heart disease mitral valve prolapse IV drug user prosthetic valves congenital HD hypertrophic cardiomyopathy
which organisms in mouth
viridans (alpha haemolytic strep)
bad dental hygiene or dental work
which organisms in native and prosthetic valve
staph aureus and staph epidermis
which organisms in prolonged hospitalisation
enterococci (gut)
which organisms in IV drug users
staph aureus
how is it diagnosed
blood cultures (3 sets) serology in culture negative if still suspected U&Es, LFTs (Alk phos raised) FBC - raised CRP Urine (proteinuria and haematuria) Echo & CXR
which antibiotics given to native valve prior to culture results
amoxicillin, gentamicin
what antibiotics given to prosthetic valve prior to culture results
vancomycin, gentamicin
which antibiotics in staph aureus
flucloxacillin
what antibiotics in strep viridans
benzylpenicilin, gentamicin
what antibiotics in enterococcus
amoxicillin/vancomycin, gentamicin
