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Foundations-Infective endocarditis > Foundations-Infective endocarditis > Flashcards

Foundations-Infective endocarditis Flashcards

1
Q

Rheumatic fever

A

Systemic immune response after beta-hemolytic streptococcal infection of pharynx

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2
Q

What valve is the most commonly affected in rheumatic fever?

A

Mitral valve

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3
Q

Minor criteria for clinical manifestations in rheumatic fever

A 
CAFE P
C-CRP elevated
A-Arthralgia
F-Fever
E-ESR elevated

P-Prolonged PR

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4
Q

Major criteria for clinical manifestations in rheumatic fever

A 
CANCER
Carditis/Valvulitis 
Arthritis 
Nodules (subcutaneous)
Chorea
Erythema marginatum 
Rheumatic fever
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5
Q

Ddx with rheumatic fever

A 
Rheumatoid arthritis
Osteomyelitis
Endocarditis
Meningitis 
SLE
Lyme disease
Sickle cell anemia
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6
Q

Jones Criteria

A 
Diagnosis of rheumatic fever
2 major criteria
	OR
1 major and 2 minor criteria
	OR (if recurrent)
3 minor criteria
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7
Q

Rheumatic Fever Treatment

A

Supportive care- bed rest
Salicylates- Aspirin
Penicillin
Prevention of recurrences

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8
Q

How many patients will develop valvulopathy after the diagnosis of rheumatic fever?

A

2/3 after 10 yrs.

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9
Q

What is a poor prognosis of rheumatic fever?

A

Persistent carditis

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10
Q

Complications of rheumatic fever

A 
Rheumatic valve disease
Heart failure
Arrhythmias
Pericarditis w/ effusion
Rheumatic pneumonitis
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11
Q

Rheumatic heart disease

A

Permanent heart valve damage subsequent to ARF

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12
Q

What is the major cause of CV dz in developing nations?

A

Rheumatic heart disease

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13
Q

Infective endocarditis

A

Microbial infection of valvular or endocardial surface of the heart

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14
Q

How does Infective endocarditis occur?

A

Bacteria will colonize on the valve and proliferate

–>start to have damage occur to the valve

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15
Q

Classifications of Infective endocarditis

A

Native valve endocarditis (own heart vavle)
Prosthetic valve endocarditis
Injection drug users

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16
Q

What valve is most likely to be involved in native valves?

A

Mitral

17
Q

What valve is most likely to be involved in injection drug users?

A

Tricuspid

18
Q

What organism causes infective endocarditis?

A

Staph aureus

19
Q

What side of the heart is more likely to be involved in infective endocarditis?

A

Right side

20
Q

What physical exam finding is very telling of infective endocarditis?

A

Regurgitant murmur or new murmur

21
Q

What peripheral lesions would you expect to find with infective endocarditis?

A 
Petechiae
Splinter/subungual hemorrhages 
Osler nodes
Janeway lesions
Roth spots
22
Q

What is the most important lab to test for suspected infective endocarditis?

A

Blood cultures

23
Q

Duke Major criteria for infective endocarditis diagnosis

A
  1. Two positive blood cultures or persistent bacteremia
  2. Echo shows evidence of endocardial involvement
  3. New regurgitant murmur
24
Q

Definitive Diagnosis for infective endocarditis

A 
2 major criteria
	OR
1 major criterion and 3 minor criteria
OR
5 minor criteria
25
Q

Bacterial Endocarditis FIVE PM

A

B- Blood Culture +
E-Endocardial Involvement: +echo; new table regurgitation.

F-Feve
I-Immunologic: glomerulonephritis; Osler nodes; Roth spots; Rf
V-Vascular : cutaneous hemorrhages, aneurysm, systemic emboli, pulmonary infarction
E-Echocardiography findings

P-Predisposition: heart condition, IV drug user
M-Microbiolgic evidence

26
Q

Empiric treatment of infective endocarditis

A

Vancomycin + Ceftriaxone

27
Q

Empiric treatment of infective endocarditis in patients with a prosthetic valve

A

Vancomycin + Rifampin + Gentamicin

28
Q

Viridans streptococci treatment in complicated infective endocarditis

A

Penicillin IV or Ceftriaxone IV

29
Q

Viridans streptococci treatment in uncomplicated infective endocarditis

A

Penicillin IV or Ceftriaxone IV

+ Gentamicin IV

30
Q

Viridans streptococci treatment in infective endocarditis with PV

A

Penicillin IV or Ceftriaxone IV x6 wks of + Gentamicin IV x2 wks

31
Q

Other streptococci treatment in infective endocarditis with PV

A

Penicillin IV OR
Ceftriaxone IV OR
Cefazolin IV

32
Q

Who do we treat prophylactically for infective endocarditis?

A

Prosthetic cardiac valve
Previous IE
Congenital heart disease
Heart transplant w/ valvulopathy

33
Q

Cardiac conditions not needing Prophylaxis for infective endocarditis

A 
MVP
RHD
Bicuspid valve disease
Calcified AS
Congenital heart disease – VSD, ASD, HOCM
34
Q

Procedures needing prophylaxis for infective endocarditis

A
  1. Dental procedures that involve:
    - Gingival tissue
    - Periapical region
    - Perforation of the oral mucosa
  2. Respiratory tract procedures that involve incision of the respiratory mucosa
    - Tonsillectomy
    - Transbronchial biopsy
  3. Procedures on infected skin, skin structure, or musculoskeletal tissue
    - Abscess drainage
35
Q

Procedures not needing prophylaxis in infective endocarditis

A 
Ear or body piercing
Tattooing
Vaginal delivery
Hysterectomy
Routine (non-cleaning) dental work
36
Q

What antibiotic would you use in prophylaxis with dental and respiratory procedures

A

Amoxicillin 2 gm PO

Foundations-Infective endocarditis (1 decks)

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