Endocarditis/pericarditis

Question 1

What kind of bacteria is associated with the following conditions in endocarditis?

• PWID
• Prosethic valves
• IV catheters
• Dental treatment

Answer 1

PWID - staph aureus
Prosethic valves - staph epidermidis
IV catheters - enterococci
Dental treatment - strep viridans

Question 2

How many blood cultures should be taken for a patient with infective endocarditis?

Should anti-microbial treatment be started before or after results?

Where should cultures be taken from?

Answer 2

3

After ideally

Peripherally to minimse risk of contaminant

Question 3

What should be done to diagnose infective endocarditis?

Answer 3

Echo

Blood cultures

Question 4

Describe some of the major and minor criteria for Duke’s Criteria

How many major/minor do you need for diagnosis?

Answer 4

Major

• 2 positive blood cultures
• Abscess formation on echo
• Vegitation on echo

Minor

• Fever
• Vascular signs e.g. Janeaway lesions
• Immunological signs e.g. Osler Nodes, +ve rheumatoid factor
• Predisposition (IV user/ previous endocarditis)
• postive blood culture that does not meet major standard

2 major + 1 minor
1 major + 3 minor
all 5 minor

Question 5

How can endocarditis present?

Answer 5

Fever
Malaise
Janeaway lesions
Osler nodes
Rosh spots

Question 6

Some organisms which cause endocarditis are viral. True or false?

Answer 6

True

- REQUIRE SEROLOGY

Question 7

Can the pancreas be effected in endocarditis?

Answer 7

No

Acute kidney injury is common though

Question 8

Which of the following are risk factors for developing endocarditis?

• COPD
• Prosthetic valve
• Colonic malignancy
• PWID
• Pneumonic
• Miscarriage
• Chronic cholecystitis

Answer 8

All but COPD

Question 9

Antibioitic treatment for endocarditis?
Timeframe?
Name of drugs?

Answer 9

4-6 weeks

Staph - vancomycin + gentamicin

Enterococcus - amoxicillin (vancomycin if allergic) + gentamicin

Viridans - benzylpenicillin + gentamicin

If prosthetic valve add RIFAMPICIN

Question 10

Osler’s nodes vs. Janeaway lesions

Answer 10

Both occur in endocarditis
Both red lil spots

Osler nodes

• occur on tips of fingers and toes
• sore (OUCH = osler)

Janeaway lesions

• occur on palms and soles
• non-painful

Question 11

Global ST and PR changes - think of what?

Answer 11

Pericarditis

Question 12

What chest pain is associated with pericarditis?

Answer 12

Central - gradual onset

Relieved by leaning forward/sitting

Question 13

Most common viral cause of pericarditis?

Answer 13

Coxsackie

Question 14

First line in treatment of pericarditis?

Answer 14

1. Treat underlying cause

2. NSAID + colchicine for idiopathic/viral pericarditis