Endocarditis

Question 1

What is meant by bacteraemia?

Answer 1

Presence of bacteria in the bloodstream

Question 2

What temperature are blood cultures kept at?

Answer 2

37’C

Question 3

The presence of bacteraemia is diagnostic of endocarditis. True/False?

Answer 3

False

Just indicates that there is infection somewhere in the body, or that samples may be contaminated

Question 4

What is the commonest coagulase -ve Staph organism?

Answer 4

Staph epidermidis

Question 5

What does Staph epidermidis commonly contaminate?

Answer 5

Skin

Prosthetic material

Question 6

What is infective endocarditis?

Answer 6

Infection of the heart valves

Question 7

What are the commonest factors that predispose to endocarditis?

Answer 7

Rheumatic disease
Congenital abnormalities
IV drug users
Calcification/sclerosis
Prosthesis/intravascular lines

Question 8

What is the general pathogenesis of endocarditis?

Answer 8

Damaged heart valves produce turbulent flow over irritated endothelium, causing platelet/fibrin deposition upon which bacteria settle, producing vegetation over the valve

Question 9

Which organism is the most common cause of native valve endocarditis?

Answer 9

Staph aureus

Question 10

Which organism is the 2nd commonest cause of native valve endocarditis?

Answer 10

Strep viridans

Question 11

Name some atypical organisms that cause endocarditis

Answer 11

Coxiella burnetti
Brucella
Gram -ve organisms
Fungi

Question 12

What are some symptoms of acute endocarditis?

Answer 12

Breathlessness
Fever
Tiredness
Malaise
Weight loss

Question 13

What are some signs of endocarditis?

Answer 13

New/louder murmur
Clubbing
Splinter haemorrhage
Splenomegaly
Roth spots, Janeway lesions, Osler nodes
Night sweats

Question 14

What are roth spots?

Answer 14

Retinal haemorrhages

Question 15

What are Janeway lesions?

Answer 15

Nodular haemorrhagic lesions on palms and soles

Question 16

What are Osler nodes?

Answer 16

Painful red lesions on palms and soles

Question 17

How many blood cultures are taken for diagnosis of endocarditis? What criteria is used?

Answer 17

3 sets (2 positive)
Dukes criteria

Question 18

If 3 blood cultures are taken and only 1 comes back positive, what might have been the cause?

Answer 18

Contamination

Question 19

Transthoracic echo is more effective than transoesophageal echo. True/False?

Answer 19

False

Question 20

What organisms are usually responsible for prosthetic valve endocarditis?

Answer 20

Staph aureus

Staph epidermidis

Question 21

Endocarditis in IV drug users predominately affects which side of the heart? What organism typically?

Answer 21

Right side (tricuspid valve)
Staph aureus

Question 22

How does Staph aureus endocarditis produce pneumonia?

Answer 22

Vegetation lodges in pulmonary circulation, causing inflammation, infection and abscess

Question 23

Which antibiotics are given for native valve endocarditis?

Answer 23

Amoxicillin IV

Gentamicin IV

Question 24

Which antibiotics are given for prosthetic valve endocarditis?

Answer 24

Vancomycin IV
Gentamicin IV
Rifampicin oral

Question 25

Which antibiotic is given for IV drug user endocarditis?

Answer 25

Flucloxacillin IV

Question 26

How long are IV antibiotics usually given for?

Answer 26

4-6 weeks

Question 27

What is monitored during endocarditis therapy?

Answer 27

Cardiac function
Temperature
Serum CRP

Question 28

What prophylaxis is used for endocarditis?

Answer 28

Antibiotics if GI or GU procedures if infection suspected

Question 29

What differentials would we consider in endocarditis?

Answer 29

Myocarditis (young people) - inflam of cardiac muscle

Pericarditis - inflam of pericardium - LOCALISED CHEST PAIN RELIEVED BY SITTING FORWARD