Endocarditis

Question 1

What is infective endocarditis

Answer 1

Inflammation of the endocardium, usually involving the heart valves, due to infection

Question 2

What valve is more commonly affected in infective endocarditis

Answer 2

Mitral valve

Tricuspid valve is implicated in IV drug users

Question 3

Risk factors

Answer 3

People already with structural heart defect
IV drug abuse
Cardiac lesions
Rheumatic heart disease
Dental treatment (requires antibiotic prophylaxis)

Question 4

Pathophysiology

Why are heart valves targeted?

Answer 4

Patients who already have a structural valve abnormality are usually affected.
Heart valves are targeted is because white blood cells cannot reach the valves due to limited blood supply of valves
Circulating bacteria adhere to the valve causing vegetations.

Question 5

Complications

Answer 5

Heart failure
Arrhythmias
Abscess formation in the cardiac muscle
Emboli formation, may cause:
Stroke, Vision loss or spread infection to other regions of the body

Question 6

Causative agents

Answer 6

Streptococcus viridans
Staphylococcus aureus
Staphylococcus epidermis
Diphtheroids
Microaerophilic streptococci
HACEK group: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
(treatment depends on causative agent)

Question 7

**Signs and symptoms

Answer 7

FROM JANE:
Fever
Roth's spots (seen on fundoscopy)
Oslers nodes (painful nodes on fingers and toes)
new Murmur

Janeway lesions (painless papules seens on the palms and plantars)
Anaemia
Nails (splinter haemorrhages)
Emboli

Question 8

Investigations

Answer 8

Blood cultures - take 3 separate cultures from 3 peripheral sites
Bloods for anaemia
Urinalysis (microscopic haematuria)
CXR
Transoesophageal/transthoracic (ECHO for vegetations)

Question 9

Conservative treatment

Answer 9

Maintain good oral hygiene

Question 10

Empirical medical treatment

Answer 10

Benzylpenicillin and Gentamicin

Question 11

Medical treatment of Streptococci

Answer 11

Benzylpenicillin (IV) and Amoxicillin

Question 12

Medical treatment of Staphylococci

Answer 12

Flucloxacillin and Gentamicin

Question 13

Medical treatment of Aspergillus

Answer 13

Miconazole

Question 14

Name heart valves

Answer 14

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Aortic (Top right)
Pulmonary
Tricuspid
Mitral (Apex)

Question 15

What classification method would you use?

Answer 15

Dukes criteria

Question 16

Describe Dukes criteria

Answer 16

3 major criteria OR 1 major criteria and 3 minor criteria OR 5 minor criteria:

Major Criteria:
2 separate positive blood cultures
Endocardial involvement

Minor criteria: FIVE:
Fever >38 degrees
IV drug user of predisposing heart condition, and
Immunological phenomena e.g. Osler’s nodes or Roth’s spots
Vascular phenomena e.g. myocotic aneurysm ro Janeway lesions
Echocardiograph findings

Question 17

What causes the murmur heard in infective endocarditis

Answer 17

Mitral regurgitation

Question 18

Echocardiogram of infective endocarditis

Answer 18

Vegetations at heart valves

Question 19

Risk factors

Answer 19

IV drug use
Congenital heart defect
Pacemaker
Prosthetic heart valves
Elderly