Endocarditis

Question 1

What is endocarditis?

Answer 1

Infection of the endothelium of the heart valves

Question 2

What are risk factors for endocarditis?

Answer 2

Heart valve abnormality
Prosthetic valves
IV drug users
IV lines
Recent dental work
Immunocompromised

Question 3

What is the most common causative organism for endocarditis?

Answer 3

Staph aureus

Question 4

What are the common causative organisms for endocarditis?

Answer 4

Staph aureus
Viridans streptococci
Enterococcus sp.
Staph epidermis
Atypicals (e.g. coxiella burnetii, chlamydia, legionella, mycoplasma)

Question 5

What are the most characteristic symptoms for endocarditis?

Answer 5

New murmur + fever

Question 6

What are the symptoms of acute endocarditis?

Answer 6

Sepsis

Cardiac failure

Question 7

What are the symptoms of sub-acute endocarditis?

Answer 7

Fever, riggers
New/changing murmur (mitral or aortic regurgitation)
Weight loss
Splenomegaly
Clubbing
Roth spots
Janeway lesions
Osler's nodes

Question 8

What are Roth spots?

Answer 8

Boat shaped retinal haemorrhages with pale centre

Question 9

What are Janeway lesions?

Answer 9

Painless palmar macules

Question 10

What are Osler’s nodes?

Answer 10

Painful purle papules on finger pulps

Question 11

What investigations are done for endocarditis?

Answer 11

Blood cultures
Serology if cultures negative (for atypical organisms)
Echocardiogram

Question 12

Which examination confirms or excludes diagnosis of endocarditis?

Answer 12

Echocardiogram

Question 13

What is the most likely causative organism in IVDU?

Answer 13

Staph aureus

Question 14

What is the most likely causative organism in patients with recent dental work?

Answer 14

Viridans streptococci

Question 15

What is the most likely causative organism in patients with prosthetic valves?

Answer 15

Staph epidermidis

Question 16

How should blood cultures be taken?

Answer 16

3 sets > 12 hours apart

Before giving antibiotics

Question 17

What are the most likely causative organisms in early prosthetic valve endocarditis?

Answer 17

Staph epidermidis or staph aureus

Question 18

What sided endocarditis is more likely in IVDU?

Answer 18

Right-sided

Question 19

What is the general management for endocarditis?

Answer 19

Empirical antibiotics

Question 20

What antibiotics are given for native valve indolent (subacute) endocarditis?

Answer 20

Amoxicillin + gentamicin IV

Question 21

What antibiotics are given for native valve severe sepsis (acute) endocarditis?

Answer 21

Flucloxacillin IV

Question 22

What antibiotics are given for prosthetic valve or suspected MRSA endocarditis?

Answer 22

Vancomycin + gentamycin IV + rifampicin PO

Question 23

What antibiotics are given for staph aureus endocarditis?

Answer 23

Flucloxacillin IV

Question 24

What antibiotics are given for MRSA endocarditis?

Answer 24

Vancomycin IV + rifampicin PO

Question 25

What antibiotics are given for viridian’s strep endocarditis?

Answer 25

Benzylpenicillin + gentamicin IV

Question 26

What antibiotics are given for enterococcus sp. endocarditis?

Answer 26

Amoxicillin/vancomycin + gentamicin IV

Question 27

What antibiotics are given for staph epidermidis endocarditis?

Answer 27

Vancomycin + gentamicin + refampicin

Question 28

How long are antibiotics given for?

Answer 28

4-6 weeks

Question 29

What is the treatment if unresponsive to antibiotics?

Answer 29

Surgery