Endocarditis

Question 1

Define bacteraemia

Answer 1

• the presence of bacteria in the bloodstream

Question 2

What are the expected bacteria for an implantable electronic device?

Answer 2

• skin organisms
• staph aureus
• staph epidermidis
• corynebacterium sp
• propionibacterium acnes

Question 3

What does biofilm mean?

Answer 3

• slow growing community of bacteria

Question 4

Risk factor for ICED infections

Answer 4

• pre procedure prophylaxis
• if the procedure is complex
• heart and renal failure
• haematoma post procedure

Question 5

Staph aureus may cause?

Answer 5

• septic shock

Question 6

What does secondary foci mean?

Answer 6

• as the infection is in the blood, it can spread to other areas of the body, such as the spine or lungs
• secondary foci

Question 7

When should blood cultures be taken?

Answer 7

• prior to starting antimicrobial therapy

Question 8

If suspicion of an ICED infection what should be done to test?

Answer 8

• suspicion of ICED infection - 3 blood cultures > 6hrs between

Question 9

Define infective endocarditis

Answer 9

• infection of the endothelium of the heart valves

- can be life threatening

Question 10

subacute meaning?

Answer 10

• slowly increasing infection

Question 11

Predisposing factors for infective endocarditis?

Answer 11

• heart valve abnormality
• prosthetic heart valve
• Intravenous drug uses
• Intravascular lines

Question 12

Pathogenesis of endocarditis?

Answer 12

• heart valve damages
• turbulent blood flow over roughened endothelium
• platelets deposited
• bacteraemia
• organisms settle

Question 13

Negative blood cultures, but other symptoms. what bacterias?

Answer 13

• coxiella burnetti (Q fever)

- bartonella

Question 14

Meaning of hacek organisms?

Answer 14

• difficult to grow bacteria

- may come back with negative blood culture at first - take longer to grow

Question 15

What is the classification system used for endocarditis?

Answer 15

• Duke’s criteria

Question 16

Sign for infective endocarditis on the hands?

Answer 16

• Osler nodes
• och - sore
• Janeways lesions
• not sore

Question 17

Gram positive and in clusters?? suggestive of?

Answer 17

• staphylococci

Question 18

What test is used to distinguish between gram positive and negative staph?

Answer 18

• coagulase test

Question 19

What is the most common coagulase negative staphylococcus?

Answer 19

• staphylococcus epidermis

* BE AWARE - if the patient has prosthetic material (e.g. iv line, heart valves e.t.c)

Question 20

Presenting symptoms of acute endocarditis?

Answer 20

• overwhelming sepsis

- cardiac failure

Question 21

Presenting symptoms of subacute endocarditis?

Answer 21

• fever
• new or changed heart murmurs
• finger clubbing
• splinter haemorrhages
• laneway lesions
• Osler nodes

Question 22

Viridans group streptococci are what colour?

Answer 22

• green

Question 23

examples of alpha haemolytic step?

Answer 23

• strep mitis

- strep sanguinis

Question 24

After a blood test what should you perform if you suspected endocarditis?

Answer 24

• trans thoracic echo (from skin)

- transoseophageal echo (down throat)

Question 25

Complications of endocarditis

Answer 25

- spread of infection through blood

Question 26

Most common side of heart effected by endocarditis for those who do not inject drugs

Answer 26

- left side

Question 27

Where would endocarditis likely effect in people who inject drugs?

Answer 27

- right tricuspid valve | - staph aureus

Question 28

Drug treatment for endocarditis straight away (empirical choices)

Answer 28

- high doses - IV to start off with - streptococcus --> amoxicillin - prosthetic valve --> vancomycin & gentamicin - drug users --> flucloxacillin

Question 29

How long on average would you treat endocarditis for with antibiotics?

Answer 29

- 4- 6 weeks - refer for surgery if failing - repeat blood culture every 2-3 days

Question 30

If lab results come back with a fungi infection endocarditis what would you do next?

Answer 30

- refer for surgery

Question 31

Prevention of endocarditis

Answer 31

- case by case | - may do antibiotic prophylaxis in some cases

Question 32

Define myocarditis

Answer 32

- viruses! | - infection of the cardiac muscle

Question 33

Pericardis usually bacteria or viruses?

Answer 33

- viruses

Question 34

Symptoms of myocarditis?

Answer 34

- fever - chest pain - shortness of breath - palpitations

Question 35

How is myocarditis diagnosed?

Answer 35

- viral PCR

Question 36

Define pericarditis?

Answer 36

- inflamed pericardium - often occurs with myocarditis - Positional

Question 37

Symptoms of pericarditis?

Answer 37

- pain when breathing in and out | - pain when moving forward and backwards

Question 38

Define cardiomyopathy

Answer 38

- any disease of the cardiac muscle | - change in heart chamber and thicknes

Question 39

Explain dilated cardiomyopathy

Answer 39

- genetic - x -linked - reduced ejection fraction

Question 40

Explain hypertrophic cardiomyopathy

Answer 40

- big heart, strong, not like dilated cardiomyopathy - heart cannot relax - may lead to sudden death

Question 41

Explain restrictive cardiomyopathy

Answer 41

- stiff heart | - heart may appear normal

Question 42

What is amyloid?

Answer 42

- abnormal deposition of abnormal protein - tends to be in beta sheets - restrictive cardiomyopathy pattern

Question 43

Explain arrhythmogenic right ventricular dysplasia?

Answer 43

- autosomal dominant - low penetrance - syncope

Question 44

What is dresslers syndrome?

Answer 44

- pericarditis post MI | - May lead to pleural effusions and cardiac tamponade

Question 45

What is the most common heart tumour?

Answer 45

- atrial myxoma