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cardiovascular > endocarditis > Flashcards

endocarditis Flashcards

1
Q

what is it

A

endovascular infection of cardiovascular structures including cardiac valves, atrial and ventricular endocardium, large intrathoracic vessels and intracardiac foreign bodies

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2
Q

consequence of what 2 things

A
  • presence of organism in blood stream

- abnormal cardiac endothelium

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3
Q

what can bacteraemia arise

A
  • poor dental hygiene
  • IV drug ise
  • soft tissue infections
  • dental treatment
  • cardiac surgery
  • pacemakers
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4
Q

does bacteraemia always result in endocarditis

A

no

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5
Q

what does damaged endocardium promote

A

platelet and fibrin deposition

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6
Q

what does increase platelet and fibrin deposition allow

A

organisms to adhere and grow, leading to an infected vegetation

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7
Q

what valves are most commonly involved

A

aortic and mitral

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8
Q

what valves are usually affected in drug users

A

right sided

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9
Q

what organisms affect the mouth

A
  • alpha haemolytic viridian’s streptococci
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10
Q

what organisms are caused by vascular catheters and antibiotic use

A

staph aureus

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11
Q

what organisms affect the gut and perineum

A

enterococci

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12
Q

what organism affect bowel malignancy

A

strep. bovis

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13
Q

what organism affect early disease of native valve replacements

A
  • staph aureus

- staph epidermis

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14
Q

what organism affect late occurring endocarditis due to valve replacements

A
  • strep viridian’s

- staph aureus

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15
Q

who is most likely to get soft tissue infections

A
  • diabetics
  • IVDUs
  • catheters
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16
Q

what organism affects soft tissue infections

A

staphylococci

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17
Q

what are rare causes of endocarditis

A

HACEK groups of organism

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18
Q

how bad are the HACEK group

A

very insidious

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19
Q

what criteria is used

A

Duke

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20
Q

what is usual cause of culture-negative endocarditis

A

prior antibiotic therapy

some duet to variety of fastidious organisms that fail to grow

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21
Q

what are examples of organism that cause gram-negative

A
  • coxiella brunetti
  • chlamydia
  • bartonella
  • legionella
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22
Q

symptoms

A
  • malaise (95%)
  • clubbing (10%)
  • murmurs (90%)
  • cardiac failure (50%)
  • arthralgia (25%)
  • pyrexia (90%)
  • osler nodes (15%)
  • splinter haemorrhages (10%)
  • janeway lesion (5%)
  • petechiae (50%)
  • Roth spots (5%)
  • splenomegaly (40%)
  • cerebral emboli (20%)
  • ## haematuria (70%)
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23
Q

what symptoms give high clinical suspicion

A
  • new valve lesion/murmur
  • embolic events of unknown origin
  • sepsis of unknown cause
  • haematuria and suspected renal infarction
  • fever plus prosthetic material in heart, IV drug user, positive blood culture
24
Q

what is major criteria for diagnosis

A
  • positive blood culture
  • positive serological test for Q fever
  • echo
  • new valvular regurgitation
25
Q

what is seen on echo

A
  • an oscillating intracardiac mass on the valve or supporting structures
  • an abscess
26
Q

what is minor criteria for diagnosis

A
  • predisposing heart condition
  • predisposing IV drug use
  • fever
  • intracranial haemorrhage
  • laneway lesion
  • osler nodes
  • Roth spots
  • ## positive blood culture but not for criteria
27
Q

what are the HACEK organisms

A
  • haemophilus
  • actinobacillus
  • cardiobacgerium
  • eikenella corrodens
  • kingella kingae
28
Q

what is very useful for diagnosis

A

echo

29
Q

what investigations should be done

A
  • blood culture
  • serological test
  • FBC
  • urea and electrolytes
  • liver biochemistry
  • inflammatory markers
  • urine
  • echo
  • CXR
  • ECG
30
Q

how is blood culture done

A

3 sets from different venepuncture sites

31
Q

when should serological tests be considered

A

culture negative cases for coxiella, legionella, chlamydia

32
Q

what is FBC

A
  • haemoglobin
  • increase white blood cells
  • increased or reduced platelets
33
Q

what is seen in liver biochemistry

A

increased serum alkaline phosphatase

34
Q

what seen in ECG

A
  • PR prolongation

- heart block

35
Q

what is seen on CXR

A
  • pulmonary oedema in left-sided disease
  • pulmonary emboli
  • abscess in right side
36
Q

length of antibiotic treatment

A

usually prolonged

37
Q

how long is the antibiotic treatment

A

4-6 weeks

38
Q

when do serum levels need to be monitored to prevent toxicity

A
  • gentamicin

- vancomycin

39
Q

what is used if patient has penicillin allergy

A
  • glycopeptides
  • vancomycin
  • teicoplanin
40
Q

what antibiotic is fundamental for therapy

A

penicillin

41
Q

treatment when results awaiting and no suspicion of staphylococci

A
  • penicillin

- gentamicin

42
Q

treatment for suspected staphylococcal endocarditis

recent surgery, acute infection

A
  • vancomycin

- gentamicin

43
Q

treatment for streptococcal endocarditis (penicillin-sensitive)

A
  • penicillin

- gentamicin

44
Q

treatment for enterococcal endocarditis

A
  • amoxicillin

- gentamicin

45
Q

treatment for staphylococcal endocarditis

A 
- vancomycin 
or 
flucloxacillin 
or 
benzypenicilin 
plus 
gentamicin
46
Q

when should most patients with endocarditis respond

A

within 48 hours of antibiotic therapy

47
Q

what is the evidence of resolution

A
  • reduced fever
  • reduction in serum markers of infection
  • relief of systemic symptoms of infection
48
Q

if there is no sign of resolution what may be happening

A
  • extension of infection
  • hospital-acquired infection
  • PE
49
Q

Is antibiotic prophylactic therapy required

A

no

50
Q

what is most common cause

A

staph aureus

51
Q

what causes it after dental work

A

viridians streptococci

52
Q

when do you always consider endocarditis

A

new murmur + fever

53
Q

treatment if caused by staph aureus

A

flucloxacillin

54
Q

treatment if caused by MRSA

A

vancomycin + rifampicin

55
Q

treatment if caused by viridian’s

A

benzylpenicillin + gentamicin

56
Q

treatment if caused by enterococcus

A

amoxicillin/vancomycin + gentamicin

57
Q

treatment if caused by staph epidermidis

A

vancomycin + gentamicin + rifampicin

cardiovascular (36 decks)

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