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Cardiology 2023 1MB > Endocarditis Creator: Cameron McCloskey > Flashcards

Endocarditis Creator: Cameron McCloskey Flashcards

1
Q

Normally, blood is ________

A

Sterile

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2
Q

What is bacteraemia?

A

The presence of bacteria in the blood

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3
Q

What is septicaemia?

A

The presence and multiplication of bacteria in the blood

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4
Q

What is infective endocarditis?

A

Infection of the heart valve endothelium

This cause valve irregularities which leads to turbulent blood flow

Valve irregularities may break free and pass into the blood

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5
Q

What are the risk factors for infective endocarditis?

A
  • Any heart valve abnormality - calcification/sclerosis, congenital, post rhematic fever
  • Prosthetic heart valaves
  • IV drug users
  • Intravascular lines
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6
Q

How does endocarditis come about?

A

There is damage to the heart valve causing turbulent blood flow

This causes deposition of platelets and fibrin

In infcetive endocarditis, microbial vegetations can settle within the platelet/fibrin thrombi

These can break off and form blockages in capillary beds

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7
Q

Bacteraemia can come about after ________ treatment

A

Dental

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8
Q

Which side of the heart is most often affected by endocarditis?

A

Left side

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9
Q

Which organisms are most likely to cause infective endocarditis?

A
  • Staph aureus (38%)
  • Step viridans (31%)
  • Enterococcus sp (8%)
  • Staph epidermidis (6%)
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10
Q

What are some more unusual examples of organisms that can cause endoarditis?

A
  • Atypical organisms
    • Bartonella, Coxiella burnetii (Q-fever), Chlamydia, Legionella, Mycoplasma, Brucella
  • Gram-negatives
    • HACEK organisms
      • Haemophilus spp. , Aggregatibacter spp**, Cardiobacterium, Eikenella sp., Kingella sp.
    • Non-HACEK gram negatives
  • Fungi
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11
Q

Why are atypical organisms hard to diagnose as the cause of endocarditis?

A

They are hard to culture, and are slow to grow

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12
Q

How often should blood cultures be taken during treatment of endocarditis?

A

Every 2-3 days until the results are negative

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13
Q

How is endocarditis diagnosed?

A
  1. Firstly a transoesophageal echo is taken
  2. The result (positive or negative) from this is confirmed by the more accurate transthoracic echo
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14
Q

What is the coagulase test?

A

Coagulase is an enzyme produced by S.aureus which converts soluble fibrinogen to insoluble fibrin

If fibrin is produced in this test S.aureus is present, and if it is not another form of staphylococcus is present

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15
Q

What is the most common coagulase negative test result for?

A

Staphylococcus epidermidis

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16
Q

Where is S.epidermidis likely to come from?

A

It can infect metal and plastic (prosthetic material) such as IV lines, prosthetic heart valves and joints.

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17
Q

What is MALDI TOF?

A

A machine that can identify the species of microorganism and most relevant treatment

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18
Q

How does acute endocarditis present clinically?

A

Cardiac failure and overwhelming sepsis

There is poor organ functiondue to lower blood pressure

Aggressive and virulent pathogens such as S.aureus cause this

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19
Q

How does subacute endocarditis differ from acute endocarditis?

A

It has a slower onset

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20
Q

Whaat are typical symptoms of subacute endocarditis?

A
  • Fever
  • Malaise
  • Weight loss
  • Tiredness
  • Breathlessness
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21
Q

What are typical signs of subacute endocarditis?

A
  • Fever
  • New or changing heart murmur
  • Finger clubbing
  • Splinter haemorrhages
  • Splenomegaly
  • Roth spots, Janeway lesions, Osler’s nodes
  • Microscopic haematuria
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22
Q

Subacute endocarditis is often cause by which bacterial group?

A

Streptococcus viridans

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23
Q

Generally the Strep viridans group will be _____ haemolytic

24
Q

When diagnosing endocarditis, how many blood cultures should be taken?

A

3

(this rules out contaminents easier)

25
Q

When blood cultures are negative, which other test may find more unusual or atypical organisms?

26
Q

Prosthetic valve endocarditis can have both early and late presentations, differentiate between the likely causes of the two

A

Early - Infected at the time of valve insertion - usually S.aureus or S.epidermidis

Late - Infected many years after valve insertion due to coincidental bacteraemia, this can be due to many bacteria

27
Q

Why is the right side of the heart most affected by endocarditis in IV drug users?

A

The venous system is used for IV drug use, so bacteria will arrive firstly at the right side of the heart

28
Q

Which heart valve is most likely affected by endocarditis in IV drug users?

29
Q

When S.aureus affects the tricuspid valve in an IV drug user causing endocarditis, what is a serious condition that may result?

A

Multiple septic pulmonary emboli released

30
Q

How is endocarditis treated if the native valve is infected?

A

Amoxicillin and gentamicin IV

31
Q

How is endocarditis treated if a prosthetic valve is infected?

A
  • Vancomycin and gentamicin (IV)
  • Rifampicin (after 3-5 days, more effective at lower bacterial load)
  • Potential valve replacement
32
Q

How is IV drug users’ endocarditis treated?

A

Flucloxacillin IV

33
Q

How is S.aureus treated in relation to endocarditis?

A

Flucloxacillin IV

34
Q

How is viridans streptococci treated in relation to endocarditis?

A

Benzylpenicillin IV and gentamicin IV

35
Q

How is S.epidermidis treated in relation to endocarditis?

A

Vancomycin and gentamicin IV and rifampicin

36
Q

What must be monitored during antibiotic treatment for endocarditis?

A
  1. Cardiac function
  2. Temperature
  3. Serum C-reactive protein
37
Q

Which organs will endocarditis primarily affect?

A
  • Brain
  • Kidneys
  • Spleen

Lungs are only effected rarely or with IV drug users

38
Q

What is marantic endocarditis?

A

This is nonbacterial thrombotic endocarditis which is an autoimmune disease

Vegetations on the heart are sterile

39
Q

What is myocarditis?

A

Condition common in young people involving inflammation and damage to the heart muscle

40
Q

What are symptoms of myocarditis?

A
  • Fever
  • Chest pain
  • Breathessness
  • Palpitations
41
Q

What are signs of myocarditis?

A
  • Arrhythmia
  • Cardiac failure
42
Q

Which pathogens can cause myocarditis?

A
  • Coxsackie A and B
  • Echovirus
  • Influenza
  • Adenovirus
43
Q

How is myocarditis diagnosed?

A
  • Viral PCR
  • Throat swab (check for influenza)
  • Stool (check for enteroviruses)
44
Q

What can often happen when an immune reaction is provoked in myocarditis?

A

An autoimune condition will result and dilated cardiomyopathy will result

This will lead to arrhythmias and sudden death

45
Q

What is pericarditis?

A

Inflammation of the pericardium

46
Q

Pericarditis can often occur alongside what ther condition?

A

Myocarditis

47
Q

What is usually the cause for pericarditis?

A

Viral causes such as:

  • Coxsackie
  • Adenoviruses
  • Influenza
  • Pneumococcus
48
Q

What is the main symptom of pericarditis?

A

Chest pain

49
Q

What can happen in pericarditis when bacteria are the cause?

A

Pus can build up in the pericardial space which is as a result of post cardiac surgery.

50
Q

What is the clinical features of MI

A

present acutely and progress rapidly with heart failure symptoms or present chronically

51
Q

most common sign of IE

52
Q

PR interval prolongation in a patient with Infective Endocarditis is an indication for surgery True/ FALSE

A

TRUE

PR prolongation or complete AV block - sign of aortic root abscess

53
Q

what is the first line of imaging investigation and what is the most sensitive for IE

A
  • Transthoracic echocardiogram is the first line imaging investigation
  • Transoesophageal echocardiogram
54
Q

A 62-year-old male with a prosthetic valve and whose blood culture results have not yet returned

A

Vancomycin IV + gentamicin IV + rifampicin PO

Random tip: native valves are the OG (original) valves  give amoxicillin and gentamicin, prosthetic valves are very good new valves  give vancomycin and gentamicin (and rifampicin)

55
Q

A 25-year-old female who is a known IV drug user and whose blood culture results have not yet returned

A

Flucloxacillin IV

56
Q

A 47-year-old male with a history of rheumatic fever whose blood culture results have not yet returned

A

Amoxicillin IV + gentamicin IV

57
Q

A 47-year-old male with a history of rheumatic fever whose blood culture results are positive for Viridians group streptococci

A

Benzylpenicillin IV + gentamicin IV

Cardiology 2023 1MB (28 decks)

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