Endocarditis notes

Question 1

Most common early endocarditis organisms in prosthetic valve are

Answer 1

Staph
fungal
gram-negative bacilli

Question 2

What are the most common in late (>1year) prostetic valve endocarditis

Answer 2

Streptocoous bovis

Enterocococci

Question 3

What are indications for operation in Prosthetic valve endocarditis

Answer 3

1. Heart Failure
	severe prosthetic dysfunction (obstruction/dehisence) causing pulmonary edema/cardiogenic shock 
	fistula to cardiac chamber/pericaridum 
	severe without dehesisance 
2. Uncontrolled infection 
	Local uncontrolled abscess
	Staph or gram negative
	persistent blood cultures x 7 days
3. Prevention of embolism 
	Large isolated vegetation > 15 mm (IIB) 
	prevention of recurrent emboli 
	large vegetation *>10mm) with other signs of CHF

Question 4

What is sensitivity of Duke Criteria

Answer 4

70-80% in native valve and less in PVE

Question 5

What are outcomes and predictors of progrnosis with early native valve prosthetic endocarditis

Answer 5

20-40% mortality 
age
staphylococcal infection 
early PVE 
HF
stroke
intracardiac abscess

Question 6

What are the HACEK group

Answer 6

Haemophilus parainfluenza
Actinobacilus 
Cardiobacterium 
Eikenella orrodens 
Kingellae 

This is a fastidious group of organisms that is associated with negative blood cultures

Question 7

Antibiotic prophylaxis is not recommended for the following

Answer 7

Colonscopy
Cystosocopy
TEE
any skin and soft tissue injuries
Intubation
Brochoscopy 
Body piercing

Question 8

What are drugs of choice for dental prophylaxis

Answer 8

Amoxicillin 2 g po pr iv (30 or 60 minutes) before procedure

if allergy

Clindamycin 600 mg po or iv

Question 9

What are recommedations for previous cardiac vavular surgery

Answer 9

Peri-operative antibiotic should be recommended

No dental surgery for 2 weeks before valvular surgery

Question 10

Which patients are recommended to have prophylaxis during high risk procedures

Answer 10

1. with a prosthetic valve or a prosthetic material used for cardiac valve repair
2. pts with previous IE
3. Patients with congenital heart disease
   cyanotic heart lesions, without surgical repair or with residual defects, palliative shunts or conduits
   congenital heart disease with complete repair with prosthetic material placed by surgery or by percutaneous technique, up to 6 months after the procedure
   when a residual defect persists at the site of implantation of a prosthetic material or device by cardiac surgery or percutaneous technique

Question 11

What is considered a high risk procedure

Answer 11

Manipulation of the gingival or periapical region of teeth or perforation of the oral mucosa (inlcuding scaling and root canal procedures)

Question 12

What are other high risk procedures where you could consider prophylaxis

Answer 12

Resp procedures that involve draining infection (invasive resp tract procedure)
GI and GU–wound infection or sepsis
Dermatological or skin—infected skin (including oral abscesses), skin structure or MSK tissue its reasonable to cover

Question 13

What is name for endocarditis resulting from advanced malignancy

Answer 13

marantic endocarditis

Question 14

What cardiac tumor is often mistaken for endocarditis

Answer 14

fibroelastoma

Question 15

What is Libman-Sacks Endocarditis

Answer 15

described in 1924, is the pathognomonic valvular lesion of systemic lupus erythematosus
or antiphsopholipid antibody syndrome that may develop on the endocardial surface of the heart

usually on the left and on the ventricular surface of the mitral valve

pea sized, (3-4mm) flat or slightly raised, granular, gray or pinkish projections, densely adherent to the endocardium, occur more at the valve rings and commissure