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Year 2 > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

What is the usual cause of infective endocarditis

A

Streptococci or Negative Staphylococci

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2
Q

Symptoms of endocarditis

A
  1. Fever
  2. Heart murmur
  3. Glomerulonephritis
  4. Night Sweats
  5. Anaemia
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3
Q

How do negative staphylococci infect the body

A

Usually present in normal oral flora but make their way into the blood via dental surgery

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4
Q

What structures does endocarditis effect

A
  1. Valves with congenital or acquired defects (left side of the heart)
  2. Normal valves by S. pneumonia or S. aureus
  3. Prosthetic valves and pacemakers
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5
Q

Under what conditions can valid on the right side of the heart be infected

A

IV DRUG ADDICTS

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6
Q

Where is endocarditis most common

A

Developing countries

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7
Q

What gender does endocarditis effect the most

A

Males

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8
Q

Most common cause of endocarditis

A

S. aureus (IVDU, diabetes and surgery)

Pseudomonas aeruginosa

S. viridian’s dental problems

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9
Q

What are three characteristics of S. viridian’s that infect the endocardium

A
  1. Gram positive
  2. alpha haemolytic and
  3. optochin resistant
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10
Q

Risk factors that effect endocarditis

A
  1. IV drug use
  2. Poor dental hygiene
  3. Skin and soft tissue infection
  4. Dental treatment
  5. IV cannula
  6. Cardiac surgery
  7. Pacemaker
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11
Q

Pathophysiology

A
  1. Consequence of: presence of organisms in bloodstream and abnormal cardiac endothelium that facilitates adherence and growth
  2. Damaged endothelium promotes platelet and fibrin deposition which adheres to organisms leading to infected vegetation
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12
Q

What calves are commonly effected

A

Aortic and mitral valves

IV drug users are exceptions

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13
Q

Long-term effect on valves

A

Organisms can destroy them resulting in regurgitating or heart failure

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14
Q

How does poor dental hygiene result in endocarditis

A
  1. Bacteria in tooth plaque can cause gum disease = bleeding and inflammation of gums causing bacteria to enter bloodstream
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15
Q

Presentation of endocarditis

A
  1. New valve lesion
  2. Embolic events of unknown origin
  3. Sepsis of unknown origin
  4. Haematuria, glumerulonehritis
  5. Fever
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16
Q

How does infection by S.aureus effect development of endocarditis

A

Develops very quickly and illness feels worse

17
Q

What can embolism of vegetations result in

A

Strokes, pulmonary embolisms

18
Q

When should endocarditis be excluded as a diagnosis in patients

A

With heart murmur and a fever

19
Q

Clinical manifestations of endocarditis

A
  1. Haemorrhages on nail beds
  2. Embolic skin lesions (black spots)
  3. Osler nodes (tender nodules in digits)
  4. laneway lesions (haemorrhages and nodules in the fingers)
  5. Roth spots (retinal haemorrhages with white or clear centres seen on fundoscopy
  6. Petechiae (small red/purple sports caused by bleeding in the skin)
20
Q

How are embolic skin lesions caused

A

Infarcts causing bits of infective vegetation blocking small capillaries

21
Q

How do we diagnose for Endocarditis

A
  1. 3 sets of blood cultures from DIFFERENT sites over 24hrs
  2. Take before antibiotics started

CRP + ESR raised
Normochromic/ normocytic anaemia
Neutrophilic

Urinalysis - haematuria
CXR - Cardiomegaly
ECG - long PR interval

Finally Echocardiograms

22
Q

What is the advantage of TTE echocardiogram

A

Safe, non-invasive, no discomfort

23
Q

Disadvantage of TTE

A

Poor images so low sensitivity but can identify vegetations (>2mm)

24
Q

Does a negative TTE exclude infective endocarditis

A

no

25
Q

Pros of TOE (tracheal oesophageal echo)

A

More sensitive, uncomfortable

BETTER AT DIAGNOSIS - exam answer

26
Q

When do we use a TOE

A

Visualising mitral lesions and checking for development of aortic root abscess

27
Q

Treatment of all types of endocarditis

A

Antibiotic for 4-6 weeks

28
Q

treatment for non-staphylococcus bacteria

A

Penicillin (benzylpenicillin + gentamicin together to be strong enough the break cell walls)

29
Q

Treatment for staphylococcus

A

Vancomycin

Rifampicin

30
Q

Surgery to cure endocarditis

A
  1. Removing valves and inserting prosthetic ones
31
Q

When is surgery used

A
  1. Infection can’t be cured with antibiotics
  2. Remove infected devices
  3. Remove large vegetations before they embolism

Year 2 (155 decks)

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