endocarditis

Question 1

what is bacteraemia

Answer 1

presence of bacteria in blood that can lead to sepsis

Question 2

what is infective endocarditis

Answer 2

infection of heart valves

Question 3

what are some risk factors of endocarditis

Answer 3

rheumatic fever (strep throat), congenital, IV drug user, valve replacement, valve disease

Question 4

what is the pathogenesis of endocarditis

Answer 4

heart valve damage which leads to turbulent flow. This can lead to platelets forming/ fibrin being deposited. Bacteraemia allows organisms to settle creating microbial vegetation

Question 5

infected vegetation are friable, why is this a concern

Answer 5

can break off and cause an abscess or haemorrhage

Question 6

what side of the heart does endocarditis normally contaminate and when would it contaminate the other side

Answer 6

left, in IV drug users the right (shoot up veins), staph A

Question 7

what are the 4 most common organisms (in order of commonness) and when youd get them

Answer 7

staph A (native), strep viridans (native and dental work), enterococcus, staph epidermis (replacement)

Question 8

what unusual organisms can cause endocarditis

Answer 8

atypical: coxiella burnetti, chlamydia, barnotella
gram -: HAEK
fungi

Question 9

how many sets of blood cultures should you take (relate to antibiotics)

Answer 9

3, before antibiotics

Question 10

if only 1 blood culture is positive what might that suggest

Answer 10

contamination

Question 11

if no blood culture is positive what might that suggest and what should happen next

Answer 11

atypical, serology

Question 12

the coagulase test separates what from what

Answer 12

staph A from coagulase -ive staph

Question 13

what is the most common coagulase -ive staph and what does it infect

Answer 13

staph epidermis, skin or prosthetic valves

Question 14

how can staph A cause pneumonia

Answer 14

by lodging in pulmonary circulation

Question 15

what is the presentation of acute endocarditis

Answer 15

severe sepsis and cardiac failure

Question 16

what is the presentation of subacute endocarditis (FROM JANE)

Answer 16

fever, roth spots, Osler nodes (sore), murmer, Janeway legions, Anaemia, Nail bed haemorrhages, Emboli

Question 17

what are clinical symptoms

Answer 17

splinter haemorrhages, clubbing, roth spots, osler nodes

Question 18

what tests are done for endocarditis

Answer 18

bloods and echo

Question 19

IV drug user (staph A)

Answer 19

IV fluclox

Question 20

what specific treatment would you use for staph A

Answer 20

IV fluclox

Question 21

what specific treatment would you use for viridans

Answer 21

benzypenicillin and gentamixin IV

Question 22

what specific treatment would you use for enterococcus

Answer 22

amoxicillin/vancomycin + gentamicin IV

Question 23

what specific treatment would you use for staph epidermis

Answer 23

vancomycin + gentamicin IV + rifampicin

Question 24

what normally causes myocarditis

Answer 24

viral Coxsackie A + B and ECHO virus

Question 25

what are the symptoms of myocarditis and how do you treat it

Answer 25

fever, chest pain, SOB, arrhythmias and cardiac failure. supportive treatment

Question 26

what normally causes pericarditis

Answer 26

viral eg ECHO, often with myocarditis

Question 27

what are the symptoms of pericarditis and how do you treat it

Answer 27

mainly chest pain, supportive treatment

Question 28

is pericarditis pain better sitting up or lying down

Answer 28

sitting

Question 29

how do you identify pericarditis

Answer 29

ECG + Heart rub

Question 30

what is Dressler’s syndome

Answer 30

Pericarditis post MI (4-6weeks after)

Question 31

what test would you do for strep viridans and entereococcus and describe when you would get it

Answer 31

haemolytic alpha and green for strep, haemolytic gamma (no) for enterococcus

Question 32

what are non bacterial thrombotic endocarditis (NBCE)

Answer 32

small numerous vegetations, associated with mucinous adenocarcinomas