ENDOCARDITIS AND INFLAMMATORY DISEASES Flashcards
what is rheumatic heart disease
inflammation of the endocardium of the heart
clinical history of rheumatic heart disease
Embolic strokes
Pulmonary embolism
Myocardial infarction
Infarction of kidney, spleen, mesenteric, skin
Immune response
risk factors for rheumatic heart disease
Prosthetic valves
Cardiac devices (permanent pacemakers, defribillators)
Intravenous drug users
Congenital Heart disease
Rheumatic valve disease (developing countries)
Mitral valve prolapse
Immunosupression
Prolonged admission to ITU/hospital (health-care associated IE)
microorganisms that are negative endocarditis
Brucella spp
Coxiella burnetti
Bartonella spp
Tropheryma whipplei
Mycoplasma spp
Legionella spp
Fungi (Candida and Aspergillus)
diagnostic imaging for infective endocarditis
transoesophageal echocardiogram
transthoracic echocardiogram
pet scans to detect prosthetic valves and intracardiac devices
major criteria of infective endocarditis
echocardiogram showing valvular vegetation
blood culture showing positive of strep viridans , staph aureus ,
minor criteria for duke criteria
cardiac lesion
intravenous drug use
temperature
embolic phenomena
immunologic phenomena
positive blood culture which doesn`t meet the major criteria
what is a definite endocarditis according to duke criteria
2 major
1 major and 3 minor criteria
5 major criteria
what is a possible endocarditis according to dukes criteria
one major plus one minor
3 minor criteria
prognosis of endocarditis
1.- Patient characteristics
Older age
Comorbidities
Diabetes
2.- Infecting microorganism
Staph aureus
Fungi
3.- Presence of cardiac/non-cardiac complications:
HF, renal failure, ischemic stroke, shock
4.- Echocardiographic findings
Periannular complications
Severe valve regurgitation,
low systolic function, large vegetations
treatment for endocarditis
iv antibiotics for 4 weeks
antibiotics used in treatment of oral streptococci or streptococci bovis group
iv penicillin or amoxicillin or ceftriaxone
antibiotics used in patients with beta lactam allergy
iv vancomycin
antibiotics used in staphylococcus attacking native valves
IV doses of flucloxacillin , clindamycin , cotrimoxazole , vancomycin , daptomycin , cotrimoxazole
duration for antibiotics therapy for prosthetic valves infection
6 weeks of therapy
what antibiotics are used for prosthetic valve therapy
rifampicin
gentamicin
empirical treatment for all valves
Ampicillin + Flucloxacillin + Gentamicin
Vancomycin + Gentamicin (if penicillin allergy)
indicators for cardiac surgery in infective endocarditis
heart failure from valvular dysfunction
uncontrolled infection
prevention embolism esp if the vegetation is very large and or many embolic episodes
epidemiology of rheumatic heart disease
common in low and middle income countries
natural history
group A bet a haemolytic strep infection (5-15) year olds
acute rheumatic fever ; carditis
rheumatic heart disease which is progressive valvular disease after years of rheumatic fever
