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B3. Cardiovascular system > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

Define Infective Endocarditis?

A

Infection of the heart material. Can include endocaridum/valves/septa/chordae tendinae/intra-cardiac devices

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2
Q

What is non-infective Endocarditis and what causes it?

A

Non-Bacterial Thrombotic Endocarditis
The formation of a sterile Fibrin-platelet vegetation due to some disruption of the valve endothelium.

Turbulent Flow - Electrodes/Catheters - Rheumatic Carditis - Degenerative Disease - Local inflammation (~25% of cases)

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3
Q

How do we classify cases of endocarditis

A

Acute/Subacute/Chronic pattern
Also which side theyre on, what structure, if a valve is it native or prosthetic, if prosthetic is it early or late? (<1yr or >1yr)

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4
Q

How can Infective endocarditis be acquired?

A
  • Via IVDA
  • Community Acquired
  • Nosocomial
  • Healthcare Related but Non-Nosocomial
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5
Q

How do the IE organisms reach the circulation?

A

From:

Extra Cardiac Infection - Invasive Procedures - Gingival Disease - Daily livinig (e.g. brushing teeth & defecating)

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6
Q

What are the risk factors for IE?

A 
Male (though women have worse prognosis
Elderly
Invasive Procedures recently
IVDA
Prosthetic Valves
Any Heart Defect/Disease
Diabetes
AIDS
Burns
Immunocompromised
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7
Q

What are the symptoms of IE?

A

FEVER - MALAISE - FATIGUE

also chills - arthralgia - weight loss - headache

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8
Q

What are the clinical signs of IE?

A

General:
Pyrexia - CHF - New Murmur - Splenomegaly - Emboli - Anaemia

Vascular:
Janeway Lesions (blood seeped into palms/soles)
Splinter Haemorrhages
Vasculitic Rash (feet, purple/red spots from burst capillaries)

Immunological:
Roth Spots (Retinal Haemorrhage)
Osler’s Nodes (Red raised painful spots of fingers, palms & soles)
Nephritis

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9
Q

When could the clinical signs be absent from IE?

A

In the elderly, immunocompromised or post antibiotic treatment

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10
Q

What does the mnemonic FROM JANE stand for?

A

Fever - Roth Spots - Oslers Nodes - Malaise - Janeway Lesions - Anaemia - Nephritis & Nail haemorrhages - Emboli

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11
Q

What details about a patient would give a high suspicion of IE?

A

Any of:
Unexplained fever - New Murmur - Known IE causin organism detected - New conduction disorder.

Also we suspect anyone with Prosthetic valves - Previous IE - CHD - New conduction Disorder - IVDA - Immunocompromised

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12
Q

What investigations are done on a suspected IE case?

A 
FBC(neutrophilia)/CRP/ESR
U + Es
Blood Cultures
Urinalysis
ECG
CXR
ECHO
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13
Q

What are we lookin for with a FBC, CRP & ESR>

A

Any markers of infection/inflammation.

E.g. neutrophilia, a high CRP and high ESR

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14
Q

What are we looking for in the Urea + Electrolytes?

A

Analyse kidney function for nephritis & sepsis

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15
Q

What are we looking for in urinalysis?

A

Blood

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16
Q

What are we looking for an ECG?

A

A conduction delay caused by IE forming an abscess over part of the bundle of his or purkinje fibres.
Wide QRS

17
Q

What shows up on a CXR in IE?

A

Heart Failure and Pulmonary Abscesses

18
Q

What kind of ECHO do we use for Infective Endocarditis?

A

A Trans-Thoracic Echo (TTE) is 1st line
TOE is used if TTE is -ve but your still suspicious OR if TTE is +ve for a better view of abscess/vegetation/complications

19
Q

What do we do if both TTE & TOE are -ve but were still suspicious of IE?

A

Repeat them 7-10 days later or earlier if theres a new complication

20
Q

How many blood cultures do we take for IE?

A

3 from different sites with 6 hours between them.

Or if they’re in septic shock then just 2 from different sites with 1 hour between them.

21
Q

Other than not having IE what else could cause -ve blood cultures?

A

Recent antibiotics
Fastidious Organisms have different diets so wont grow on blood culture (Nutritionally varied Strep - HACEK gram -ve bacilli - Brucella - Fungi)
Nor would Intracellular Bacteria (Coxiella Burnetii - Bartonella - Chlamydia)

22
Q

What are the common complications of IE?

A

Heart Failure - Fistula Formation - Leaflet Perforation - Uncontrolled Infection - Abscess Formation - Atrioventricular Heart Block - Embolism - PVE & PV dysfunction

23
Q

What criteria are needed to have a sure diagnosis of IE?

A

Either 2 Major, 1M & 3m or 5minor of the Modified Duke Criteria for a firm diagnosis

24
Q

What are the Major Duke criteria?

A
  • IE causing organisms in 2 seperate blood cultures
  • IE organisms found in persistant blood cultures
  • +ve blood culture for Coxiella Burnetii
  • +ve ECHO
  • New Murmur
25
Q

What are the minor Duke Criteria?

A
  • Predisposition (IVDA or Heart Condition)
  • Fever
  • Vascular Signs
  • Immunologic Signs
  • Microbiological evidence that doesnt meet the major duke critera (serology or blood culture)
26
Q

What IE organisms show up in +ve blood culture?

A

Strep: Oral Viridans group - Miller/Aginosus Group - Bovis/Equinus complex (Group D Strep)

Staph: Aureus (Makes up most HCA IE) - Coagulase -ve stpah (CNS) epidermis

Enterococci - Faecalis/Faecium/Durans

27
Q

How do we empirically treat IE? (I.e. before the blood cultures come back)

A

We use 2 IV antibiotics at once, AFTER the bloods are taken.

Standard is Gentamicin + Amoxicillin

28
Q

What do we use to empirically treat IE if the patient is severely septic, allergic to penicillin or infected with MRSA?

A

Gentamicin + Vancomycin (replacing the amoxicillin)

29
Q

What Antibiotic do we add if the patient has infected prosthetic valves?

A

Rifampicin

30
Q

When do we use surgery as well as antibiotics?

A

The complications are indicators surgery is now necessary

31
Q

How do we treat fungal IE?

A

With dual antifungals, often for life. And usually valve replacement too.

32
Q

In what patients does Fungal IE occur?

A

In PVE/IVDA/immunocompromised patients.

33
Q

FROM JANE?

A

Fever - Roth Spots - Oslers Nodes - Malaise - Janeway Spots - Anaemia - Nephritis (Nail haemorrhages) - Emboli

34
Q

What are the vascular signs of IE?

A

Janeway Lesions
Splinter Haemorrhages
Vasculitis Rash

35
Q

What are the immunological signs of IE?

A

Roth spots
Oslers Nodes
Nephritis

36
Q

When is amoxicillin replaced with vancomicin in empirical IE treatment?

A

If the patient has severe sepsis, is allergic to penicillin or has MRSA

B3. Cardiovascular system (49 decks)

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