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Cardiology > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

What is quorum sensing?

A

The ability to respond to cell population density by gene regulation

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2
Q

What is the most commonly seen type of infectious endocarditis?

A

Native valve endocarditis

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3
Q

What is the most common cause of native valve endocarditis?

A

S.viridans

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4
Q

Gram positive bacteria more commonly cause infectious endocarditis. T/F?

A

True

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5
Q

Which organism is the most common cause of IVDU endocarditis?

A

Staphylococcus aureus

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6
Q

There is a higher likelihood of gram negative and fungal infectious causes in IVDU endocarditis compared to native valve endocarditis. T/F?

A

True

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7
Q

What is the most common cause of prosthetic valve endocarditis?

A

Staphylococci

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8
Q

Which gender is more likely to get endocarditis?

A

Men

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9
Q

What are the risk factor for native valve endocarditis?

A

Valve abnormalities such as aortic stenosis and mitral valve prolapse
IV drug use

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10
Q

In the UK, what is the most common cause of aortic stenosis?

A

Calcification of the valve

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11
Q

How can rheumatic fever cause aortic stenosis?

A

Streptococcus progenies infection which is either not treated or only partially treated results in the formation of anti-steptolysin O antibodies which in addition to attacking the bacteria also attack the cardiac valves

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12
Q

Why does IVDU endocarditis primarily affect the right sided heart valves?

A

Blood returning from the circulation enters the right side of the heart first so this side of the heart is more exposed to drugs.

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13
Q

Which bacterial is most likely to cause an acute endocarditis?

A

S.aureus

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14
Q

Which bacteria is most likley to cause subacute endocarditis?

A

Strep. viridians

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15
Q

How long does the injection usually take to present in infectious endocarditis?

A

2 weeks

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16
Q

The presence of both a fever and a murmur suggests which diagnosis until proven otherwise?

A

Infectious endocarditis

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17
Q

Fever can be absent in elderly patients with endocarditis. T/F?

A

True

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18
Q

In addition to fever and murmurs, what common complaints might you expect in infectious endocarditis?

A

Fatigue

Malaise

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19
Q

What are the hallmarks of embolic disease in infectious endocarditis?

A

Splinter haemorrhages
Conjunctival petechiae
Septic pulmonary emboli

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20
Q

What are the more catastrophic effects which can occur as a result of embolism of infectious endocarditis?

A

Stroke

Renal infarction

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21
Q

Septic pulmonary emboli are more commonly seen in infectious endocarditis affecting which side of the heart?

A

Right side

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22
Q

What are the possible immunological damages that can occur due to infectious endocarditis?

A

Splenomegaly
Nephritis
Vasculititic lesions of the skin and eye
Finger clubbing

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23
Q

What. are the possible direct. tissue damages that can occur due to infectious endocarditis?

A

Valve destruction

valve abscess formation

24
Q

Osler’s nodes can occur as late effects of infection in patients with infectious endocarditis. What are Osler’s nodes?

A

Painful, palpable lesions found on the hands and feet

25
Q

When should a diagnosis of infectious endocarditis be considered?

A

All patients with s.auerus bacteraemia
IV drug users with any positive blood cultures
All patients with prosthetic valves and positive blood cultures

26
Q

There is constant bacteraemia in infectious endocarditis. What is the implication of this with regard to taking blood cultures?

A

There is no need to wait for a fever before taking a blood culture

27
Q

Blood culture samples should be taken before antibiotics are given. T/F?

A

True

28
Q

Describe the pros and cons of trans-thoracic versus tranoesophageal echocardiograms?

A

Trans-thoracic is non-invasive but only has a 50\5 sensitivity
Transoesophageal is invasive but has a much higher sensitivity of 85-100%

29
Q

What are the major criteria of the Duke criteria of infectious endocarditis?

A

Typical organism present in 2. separate blood cultures

Positive echocardiogram or new valve regurgitation

30
Q

What are the minor criteria of the Duke criteria of infectious endocarditis?

A

Predisposition e.g. heart condition or IVDU
Fever >38
Vascular phenomenon e.g. septic emboli
Immunological phenomena e.g. Osler’s nodes
Positive blood cultures which did not meet the major criteria

31
Q

Describe how the major and minor criteria of the Duke criteria can be used to determine the likelihood of infectious endocarditis.

A

Likely to be IE if: 2 major criteria or 1 major and 3 minor criteria or 5 minor criteria

32
Q

Bacteriostatic agents are used in the treatment of infectious endocarditis. T/F?

A

False - bactericidal agents are used

33
Q

IV therapy is given for the duration of treatment in most cases of infectious endocarditis. T/F?

A

True

34
Q

For how long are IV antibiotics typically given in native valve endocarditis?

A

4 weeks

35
Q

For how long are IV antibiotics typically given in prosthetic valve endocarditis?

A

6 weeks

36
Q

What antibiotics cans be used to treat endocarditis as a result of streptococcus infection?

A

Benzylpenicllin +/-Gentamicin.

37
Q

What antibiotics cans be used to treat endocarditis as a result of s.aureus (MSSA) infection?

A

Flucloxacillin +/- gentamicin

38
Q

What antibiotics cans be used to treat endocarditis as a result of s.aureus (MRSA) infection?

A

Vancomycin +/- gentamicin

39
Q

What antibiotics cans be used to treat endocarditis as a result of enterococcus infection?

A

Amoxicillin or vancomycin +/- gentamicin

40
Q

What antibiotics cans be used to treat endocarditis as a result of CoNS infection?

A

Vancomycin +/- gentamicin +/- rifampicin

41
Q

What are the indications for surgical intervention in infectious endocarditis?

A

Heart failure
Uncontrolled infection
Prevention fo embolism for large vegetations (>10mm). or following one or more embolic episodes

42
Q

What signs of uncontrolled infection can indicate the need for surgical intervention in endocarditis?

A

Local uncontrolled infection e.g. abscess, false aneurysm, enlarging vegetation
Persisting fever and positive blood culture for more than 7-10 days
Infection caused by fungi or multi antimicrobial resistant microorganisms

43
Q

What are the common clinical signs and symptoms of infective endocarditis?

A

Fever often associated with chills, anorexia, weight loss
Malaise, myalgia, arthralgia, night sweats
Dyspnoea
Cardiac. murmurs
Splenomegaly
Petechiae
Splinter haemorrhages

44
Q

What are Janeway lesions?

A

Nontender erythematous mucules on the palms and soles

Janeway lesions are relatively uncommon clinical manifestation of infectious endocarditis.

45
Q

What are Roth spots

A

Relatively uncommon clinical manifestation of infectious endocarditis
Exudative, oedematous haemorrhage retinal lesions

46
Q

How should blood cultures be taken when dealing with a possible bacterial endocarditis?

A

3 sets of blood cultures taken from peripheral veins at different point. 10ml of blood in each bottle. Meticulous sterile technique. Taken prior to antibiotics

47
Q

What is the most significant factor in identifying microorganisms from blood cultures?

A

The volume of blood collected

48
Q

Why should taking blood culture samples for central venous catheters be avoided/

A

This gives a high risk of contaminants and misleading findings

49
Q

Give example fo gram negative rod bacteria?

A

E.coli
Klebsiella
Pseudomonas

50
Q

Give an example. fo a gram negative cocci bacteria

A

Neisseria

51
Q

What bacteria are the most common contaminants in blood cultures?

A

Coagulase negative staphylococci

52
Q

Why are gram negative bacteria found in blood culture unlikely to be contaminants?

A

Usually contaminants are commensal organisms from the skin which are usually gram positive

53
Q

What are the two types fo alpha-haemolytic streptococci bacteria?

A

Streptococcus pneumoniae

Streptococcus viridans

54
Q

What are the three types of beta haemolytic streptococci?

A

Group A. - streptococci pyogenes
Group B - streptococci agalactiae
Group C - enterococcus

55
Q

Streptococci bacteria can be further classified by their ability to haemolyse blood agar. T/F?

A

True

Cardiology (8 decks)

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