Endocarditis Flashcards
1
Q
Endocarditis physical findings
A
- New regurgitation heart murmur
- Painful Osler nodes on the pads of the digits
- Nonpainful Janeway lesions macular/nodular hemorrhagic on the palms or soles
- Splinter hemorrhages
- Roth spots
2
Q
Endocarditis, history of prosthetic valve
A
- If occurring within 2 months of prosthetic valve placement, means the implanted valve was infected. Hard to treat, especially with S. epidermidis. If no response to 1 round of adequate antibiotics, replace valve.
- If occurring >2 months since prosthetic valve placement, antibiotic treatment is generally sufficient. Valve must be replaced if there is evidence of valve ring infection, myocardial penetration (new heart block/bundle branch block), or unstable prosthesis.
- Surgery indicated for refractory heart failure, usually from acute valve regurgitation, extension of infection to the myocardium, perivalvular abscess, failure of medical treatment, or large vegetations with systemic emboli or recurrent emboli on adequate therapy.
3
Q
Endocarditis antibiotic prophylaxis guidelines
A
- Prophylaxis no longer indicated for GI/GU surgeries.
- 👀Prophylaxis prior to dental procedures now only indicated in highest risk cardiac conditions: Prosthetic valves (mechanical or bioprosthetic), history of endocarditis, congenital heart disease: Unrepaired cyanotic congenital heart disease, repaired congenital heart disease within 6 months, repaired congenital heart disease with residual defects, cardiac transplant without lesions.
- Prophylaxis not indicated for bicuspid aortic valve, ASD or VSD unless unrepaired AND cyanotic or repaired with residual defect, native valvular stenosis or regurgitation, mitral valve prolapse, CABG, or HCM unless repaired within 6 months.
4
Q
👀Antibiotic prophylactic regimens
A
- Oral: Amoxicillin 2 g, or if penicillin allergic-clindamycin 600 mg, cephalexin 2 g, or azithromycin/clarithromycin 500 mg.
- Unable to take oral: Ampicillin 2 g IM/IV, cephalexin/ceftriaxone 1 g IM/IV
- Penicillin allergic and unable to take oral: Clindamycin 600 mg IM, cefazolin/ceftriaxone 1 g IM/IV
