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ICM -- Cardiology > ICM -- Infective Endocarditis > Flashcards

ICM -- Infective Endocarditis Flashcards

1
Q

Risk factors for Infective Endocarditis?

A 
IVDA
Poor Dental Hygiene
Dialysis/Indwelling Catheter
Diabetes
Prosthetic Valves
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2
Q

What is infective endocarditis?

A

A microbial infection of the endocardium of the heart

Inner lining, chordae tendinae, valves

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3
Q

What organisms cause IE?

A

Staph aureus (G+, slow clearing)
Coag negative staph (saph. epi) (Early prosthetic valve IE)
Streptococci (mutans, sanguis, bovis)

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4
Q

Someone gets strep bovis – what do you do

A

Colonoscopy

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5
Q

Uncommon infections leading to IE

A 
Haemophillus
Actinobacillus
Cardiobacterium hominis
Eikenella
Kingella kingae
(enterococci, fungi, coxiella)
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6
Q

Signs and symptoms of IE?

A 
FEVER + MURMUR
Weight Loss, Fatigue
Heart Failure
Night Sweats
Skin Petechiae or Conunctival hemorrhages
Splinter hemorrhages
Osler Nodes
janeway lesions
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7
Q

What are osler nodes?

A

Painful, swollen subcutaneous nodules on the pulp of the fingers and toes

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8
Q

What are Janeway lesions?

A

Nontender nodules on the palms of the soles

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9
Q

Janeway vs. Osler. Location?

A

J – Soles/Palms/Plantar Surfaces

O – Finger and toe tips, thenar/hypothenar eminences

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10
Q

Janeway vs. Osler. Size and Shape

A

J – Macules of variable size/shape

O – 1mm or greaer

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11
Q

Janeway vs. Osler. Tender?

A

Just Osler

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12
Q

Janeway vs. Osler. Course?

A

J – Days to weeks

O – Hours to days

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13
Q

Janeway vs. Osler. Type of Endocarditis?

A

J – Acute

O – Subacute

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14
Q

Janeway vs. Osler. Culture?

A

J – Positive

O – Negative

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15
Q

Janeway vs. Osler. Histology?

A

J – Septic microemboli

O – Vasculitis

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16
Q

Perivalvular abscess can cause…

A

Valve dysfunction
Heart Block
Stroke

17
Q

What do you use to diagnose IE?

A

The Modified Dukes Criteria

2 major, 1 major+3 minor, 5 minor

18
Q

Major criteria for IE diagnosis

A
  1. Lab evidence (2+ blood cultures, 1 for cox)
  2. Endocardial involvement (Echocardiogram)
  3. New valvular regurgitation
19
Q

Minor criteria for IE diagnosis

A 
Predisposing Heart Condition
Fever
Vascular phenomenon
Immunologic Phenomenon
Positive Blood Culture (not from one of the major causes)
20
Q

Examples of vascular phenomenon associated with IE?

A

Emboli (Janeway), Mycotic Aneurysm, Hemorrhageshi

21
Q

Examples of immunologic phenomenon associated with IE?

A

Glomerulonephritis, Osler Nodes, Rh factor

22
Q

How do you treat IE before you know about sensitivity?

A

Vancomycin plus Aminoglycoside

23
Q

How do you treat IE after you know about sensitivity?

A

PCN sens – PCN or Ampicillin + Aminoglycoside
PCN insens – Vancomycin + Aminoglycoside
2-6 Weeks IV antibiotics

24
Q

Do you use anticoagulation treatments for endocarditis?

A

Nope

25
Q

Defining symptom of pericarditis

A

Chest Pain

26
Q

Defining characteristic of carcinoid syndrome patients

A

Flushed

27
Q

The best first test for a potential endocarditis patient

A

Blood cultures

28
Q

Which endocarditis patient should get a transesophageal echo?

A

Ones with a prosthetic valve

29
Q

Name for the retinal hemorrhages associated with endocarditis?

A

Roth Spots

30
Q

Which murmurs increase with inspiration?

A

Right side of heart

31
Q

Septic emboli in the lung + IE is associated with

A

IV drug use

32
Q

Best step to take for an IE patient following blood cultures?

A

Start antibiotics

33
Q

What is Red Man Syndrome? What do you do about it?

A

Reddness and flushing at the neck line occuring after treatment with vancomycin caused by histamine release from mast cells. Treat by decreasing the rate of infusion.

34
Q

Equation for sensitivity

A

(True Positives) / (TP + False Negatives)

35
Q

Equation for specificity?

A

True Positives / (TP+False Positives)

36
Q

Alcoholic homeless flea bitten people are associated with what infection?

A

Bartonella

37
Q

Indications for IE prophylaxis?

A 
Prosthetic Valve
Heart Transplant Recipient
Previous endocarditis
Cyanotic Heart Disease
PLUS: Dental Work (w/bleeding) or tonsillectomy.
38
Q

How do you modify treatment if the infection is in a prosthetic valve?

A

Add rifampin

ICM -- Cardiology (9 decks)

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