Endocarditis

Question 1

what is endocarditis

Answer 1

infection of endothelium of heart valves

valve inflammation

Question 2

what are the risk factors for endocarditis

Answer 2

heart valve abnormality (calcification in elderly, congenital heart disease, post rheumatic fever), prosthetic heart valve
IV drug users
IV lines

Question 3

what is the cause of endocarditis

Answer 3

1) infection with organism
2) damaged endothelium causes platelet and fibrin deposition, organism grows (infected vegetation)
3) non laminar flow

Question 4

what valves are most commonly affected in endocarditis

Answer 4

mitral (then aortic)

Question 5

what valves are most commonly affected in IV drug users endocarditis

Answer 5

right sided eg. tricuspid

Question 6

what are the 2 types of endocarditis

Answer 6

infectious and non infectious

Question 7

what are the complications of endocarditis (organism vegetation in valve)

Answer 7

abscess or haemorrhage

Question 8

what people commonly present with endocarditis

Answer 8

• Rheumatic heart disease, complicates this disease
• prosthetic valves,
• congenital defects,
• MV prolapse,
• calcific disease
• IV drug abusers
• Older
• Diabetic mellitus
• Septicaemia
• Poor dental hygiene
• Hospital acquired (staph aureus)

Question 9

what is the most common organism causing endocarditis

Answer 9

staphylococcus aureus

Question 10

what are the 4 organism causing endocarditis native valve

Answer 10

staph aureus (38%)
viridians streptococci (31%)
enterococcus sp (8%)
staph epidermidis (6%)

Question 11

what organism causes endocarditis through skin infection

Answer 11

staph epidermis (coagulase negative)

Question 12

other than staph epidermis what is another skin contaminant

Answer 12

Corynebacterium sp. (diptheroids)

Question 13

what organism commonly infects prosthetic material eg. IV line infection or prosthetic heart valve

Answer 13

staph epidermidis

Question 14

what atypical cause endocarditis

Answer 14

o	Bartonella
o	Coxiella burnetti (Q fever)
o	Chlamydia
o	Legionella
o	Mycoplasma 
o	Bruella

Question 15

what organism causes endocarditis in IV drug users

Answer 15

staph aureus (they also get septic PE)

Question 16

what organism causes acute endocarditis

Answer 16

staphylococcus

skin infection

Question 17

what organism causes subacute endocarditis

Answer 17

streptococcus viridians

heart valves

Question 18

what Gm-ve organisms cause endocarditis

Answer 18

	Hamophilus
	Actinobacillus
	Cardiobacteria
	Eikenella
	Kingella

Question 19

what are the complications of endocarditis

Answer 19

heart failure
renal failure
Abscess, fistula, pericarditis 
Brian haemorrhage
Stroke 
Septic shock

Question 20

symptoms of endocarditis

Answer 20

• Fever
• Malaise
• Tiredness
• breathlessness

Question 21

signs of endocarditis

Answer 21

• Sepsis/septicaemia
• Cardiac failure
• Osler nodes
• Janeway lesions
• Roth spots
• Spliner haemorrhages
• Systemic septic embolic: brain, kidney
• Mycotic aneurysms
• Finger clubbing
• Murmur
• Embolic event
• Haematuria (microscopic), glomerulonephritis, renal infarction
• Fever
• Splenamegaly

Question 22

how is endocarditis diagnosed

Answer 22

blood cultures

for atypical: blood culture, serology, immunohisotchdemistry, PCR

Question 23

treatment of native valve endocarditis due to strep viridans

Answer 23

amoxicillin + gentamycin IV

Question 24

what should be used to treat endocarditis if penicillin allergic

Answer 24

vancomycin

Question 25

what is the treatment of prosthetic valve endocarditis (MRSA)

Answer 25

o Vancomycin + gentamycin (IV) o Add in day 3-5 rifampidn PO o Often valve replaced

Question 26

treatment of IV drug users endocarditis (MSSA)

Answer 26

IV flucloxacillin

Question 27

treatment of staphylococcus aureus

Answer 27

IV fluclocacillin

Question 28

treatment of enterococcus

Answer 28

Amoxicillin/vancomycin + gentamycin

Question 29

treatment of staphylococcus epidermis

Answer 29

vancomycin + gentamicin IV + rifampicin PO

Question 30

what organisms can be treated with OPAT (out parenteral antibiotic therapy_

Answer 30

streptococci or strep bovis only in stable patient

Question 31

what are the causes on non-infectious endocardits

Answer 31

rheumatic fever SLE non-bacterial thrombic endocarditis carcinoid disease

Question 32

what is cardinoid disease

Answer 32

neoplasm of neuroendocrine cells in GI mucosa, carcinoid syndrome (= liver metastases) excess 5HIAA, serotonin, histamine, bradykinin

Question 33

signs of carcinoid heart disease

Answer 33

skin flushing | nausea, vomitting, diarrhoea

Question 34

what does carcinoid heart disease cause

Answer 34

right sided cardiac valve disease | tricuspid + pulmonary insufficiency

Question 35

what is non-bacterial thrombotic endocarditis

Answer 35

``` marantic endocardits (cancer) non invasive doesn't destroy valves mutinous adenocarcinoma hypercoaguable states ```

Question 36

what are laneway lesions/osler's nodes a sign of

Answer 36

subacute bacterial endocarditis

Question 37

what are the Minor FIIVE classification of endocarditis

Answer 37

Fever >38 oC IV drug user or predisposing heart condition, and Immunological phenomena (eg Osler’s nodes, Roth’s spots) Vascular phenomena, e.g. mycolytic aneurysm/Janeway L’s Echocardiograph findings

Question 38

what is the main investigations for endocarditis

Answer 38

``` B: 3 separate positive blood cultures from 3 peripheral sites B: bloods for ananemia U: urinalysis, microscopic haematuria CxR Echo (transosophageal/transthoracic) ```

Question 39

what is the treatment of  Native valve severe sepsis and risk factors for resistant pathogens

Answer 39

vancomycin IV + meropenem IV