endocarditis Flashcards
what is bacteraemia
presence of bacteria in blood that can lead to sepsis
what is infective endocarditis
infection of heart valves
what are some risk factors of endocarditis
rheumatic fever (strep throat), congenital, IV drug user, valve replacement, valve disease
what is the pathogenesis of endocarditis
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
infected vegetation are friable, why is this a concern
can break off and cause an abscess or haemorrhage
what side of the heart does endocarditis normally contaminate and when would it contaminate the other side
left, in IV drug users the right (shoot up veins), staph A
what are the 4 most common organisms (in order of commonness) and when youd get them
staph A (native), strep viridans (native and dental work), enterococcus, staph epidermis (replacement)
what unusual organisms can cause endocarditis
atypical: coxiella burnetti, chlamydia, barnotella
gram -: HAEK
fungi
how many sets of blood cultures should you take (relate to antibiotics)
3, before antibiotics
if only 1 blood culture is positive what might that suggest
contamination
if no blood culture is positive what might that suggest and what should happen next
atypical, serology
the coagulase test separates what from what
staph A from coagulase -ive staph
what is the most common coagulase -ive staph and what does it infect
staph epidermis, skin or prosthetic valves
how can staph A cause pneumonia
by lodging in pulmonary circulation
what is the presentation of acute endocarditis
severe sepsis and cardiac failure
what is the presentation of subacute endocarditis (FROM JANE)
fever, roth spots, Osler nodes (sore), murmer, Janeway legions, Anaemia, Nail bed haemorrhages, Emboli
what are clinical symptoms
splinter haemorrhages, clubbing, roth spots, osler nodes
what tests are done for endocarditis
bloods and echo
IV drug user (staph A)
IV fluclox
what specific treatment would you use for staph A
IV fluclox
what specific treatment would you use for viridans
benzypenicillin and gentamixin IV
what specific treatment would you use for enterococcus
amoxicillin/vancomycin + gentamicin IV
what specific treatment would you use for staph epidermis
vancomycin + gentamicin IV + rifampicin
what normally causes myocarditis
viral Coxsackie A + B and ECHO virus
what are the symptoms of myocarditis and how do you treat it
fever, chest pain, SOB, arrhythmias and cardiac failure. supportive treatment
what normally causes pericarditis
viral eg ECHO, often with myocarditis
what are the symptoms of pericarditis and how do you treat it
mainly chest pain, supportive treatment
is pericarditis pain better sitting up or lying down
sitting
how do you identify pericarditis
ECG + Heart rub
what is Dressler’s syndome
Pericarditis post MI (4-6weeks after)
what test would you do for strep viridans and entereococcus and describe when you would get it
haemolytic alpha and green for strep, haemolytic gamma (no) for enterococcus
what are non bacterial thrombotic endocarditis (NBCE)
small numerous vegetations, associated with mucinous adenocarcinomas
