HIGH YIELD

Question 1

infection of the endocardial surface of the heart

usually one or more valves

can also include cardiac devices

non infectious causes of endocarditis

• nonbacterial thrombotic endocarditis
• marantic endocarditis

Answer 1

infective endocarditis )IE)

Question 2

how is infective endocarditis classified?

Answer 2

native valve
• Acute – < 1-2 weeks
• Subacute– >2 weeks

prosthetic valve
• Early Onset– < 2 months
• Late Onset– > 2 months

Question 3

RF?

Answer 3

males>females in all series
prior thematic heart disease
injection drug use
poor dentition
history of prior endocarditis
intravascular device infection
chronic hemodialysis

Question 4

About 3 out of 4 have a pre-existing underlying

structural cardiac abnormality like?

Answer 4

mitral valve (25-30%)
-mitral valve prolapse w/o regurgitation-small risk

aortic valve (12-20%)

• aortic stenosis
• bicuspid aortic valve

Question 5

how are cardiac lesions classified?

Answer 5

high risk

• prosthetic valve
• cardiac valve repair
• cyanotic congenital heart disease
• valve regurgitation in a transplanted heart

moderate risk

• bicuspid aortic valve
• mitral valve prolapse with MR

lower risk
-tricuspid regurgitation, pulmonic regurgitation

Question 6

pathophysiology based on?

Answer 6

valvular infection with local destruction and contiguous infection

bland or septic embolization

sustained bacteremia

circulating immune complexes

Question 7

number 1 cause of endocarditis according to international collaboration on endocarditis?

Answer 7

staph aureus

negative cultures, 10%

Question 8

number 1 cause of prosthetic valve endocarditis?

Answer 8

coagulase negative staph
early onset:31-35
late onset:15

Question 9

major infective endocarditis?

Answer 9

fever, 80%

stroke, 20%

Question 10

causes of culture negative infective endocarditis?

Answer 10

• Prior receipt of antibiotics***
• Bartonella henslae– (cat scratch disease)
• Tropheryma whipplei (Whipple’s disease)
• Coxiella burnetti (Q fever, zoonotic)- Duke Guidelines

Question 11

two major duke criteria?

Answer 11

bacteremia

evidence of endocardial involvement

Question 12

surgical indications in endocarditis?

Answer 12

refractory CHF

> 1 serious embolic event

uncontrolled infection

Question 13

cardiac conditions at risk for endocarditis?

highest risk?
moderate risk?

Answer 13

prosthetic valves
previous endocarditis
cyanotic congenital heart disease, unrepaired

acquired valvular dysfunction
hypertrophic cardiomyopathy

Question 14

cardiac conditions at negligible risk for endocarditis?

Answer 14

isolated atrial septal defect

surgically repaired ASD, VSD, PDA

prior CABG

mitral valve prolapse without regurgitation

cardiac pacemakers

Question 15

when are prophylactic Abx required?

Answer 15

if high risk

• dental procedures
• perforation of oral mucosa
• respiratory tract procedures

Question 16

when are prophylactic Abx not required?

Answer 16

dental restoration
placement or adjustment of braces
flexible bronchoscopy w/o biopsy

Question 17

antiobiotic regiment for prevention of endocarditis?

Answer 17

• Oral: amoxicillin 2 grams x 1, 30-60 minutes prior
• Penicillin allergy:
• cephalexin 2 grams x 1, or
• clindamycin 600 mg x 1, or
• azithromycin or clarithromycin 500 mg x 1

• Unable to take oral antibiotics

• Amoxillin 2 grams IM or IV x 1, or
• Cefazolin or ceftriaxone 1 gram IM or IV x 1