ICM -- Infective Endocarditis Flashcards
Risk factors for Infective Endocarditis?
IVDA Poor Dental Hygiene Dialysis/Indwelling Catheter Diabetes Prosthetic Valves
What is infective endocarditis?
A microbial infection of the endocardium of the heart
Inner lining, chordae tendinae, valves
What organisms cause IE?
Staph aureus (G+, slow clearing)
Coag negative staph (saph. epi) (Early prosthetic valve IE)
Streptococci (mutans, sanguis, bovis)
Someone gets strep bovis – what do you do
Colonoscopy
Uncommon infections leading to IE
Haemophillus Actinobacillus Cardiobacterium hominis Eikenella Kingella kingae (enterococci, fungi, coxiella)
Signs and symptoms of IE?
FEVER + MURMUR Weight Loss, Fatigue Heart Failure Night Sweats Skin Petechiae or Conunctival hemorrhages Splinter hemorrhages Osler Nodes janeway lesions
What are osler nodes?
Painful, swollen subcutaneous nodules on the pulp of the fingers and toes
What are Janeway lesions?
Nontender nodules on the palms of the soles
Janeway vs. Osler. Location?
J – Soles/Palms/Plantar Surfaces
O – Finger and toe tips, thenar/hypothenar eminences
Janeway vs. Osler. Size and Shape
J – Macules of variable size/shape
O – 1mm or greaer
Janeway vs. Osler. Tender?
Just Osler
Janeway vs. Osler. Course?
J – Days to weeks
O – Hours to days
Janeway vs. Osler. Type of Endocarditis?
J – Acute
O – Subacute
Janeway vs. Osler. Culture?
J – Positive
O – Negative
Janeway vs. Osler. Histology?
J – Septic microemboli
O – Vasculitis
Perivalvular abscess can cause…
Valve dysfunction
Heart Block
Stroke
What do you use to diagnose IE?
The Modified Dukes Criteria
2 major, 1 major+3 minor, 5 minor
Major criteria for IE diagnosis
- Lab evidence (2+ blood cultures, 1 for cox)
- Endocardial involvement (Echocardiogram)
- New valvular regurgitation
Minor criteria for IE diagnosis
Predisposing Heart Condition Fever Vascular phenomenon Immunologic Phenomenon Positive Blood Culture (not from one of the major causes)
Examples of vascular phenomenon associated with IE?
Emboli (Janeway), Mycotic Aneurysm, Hemorrhageshi
Examples of immunologic phenomenon associated with IE?
Glomerulonephritis, Osler Nodes, Rh factor
How do you treat IE before you know about sensitivity?
Vancomycin plus Aminoglycoside
How do you treat IE after you know about sensitivity?
PCN sens – PCN or Ampicillin + Aminoglycoside
PCN insens – Vancomycin + Aminoglycoside
2-6 Weeks IV antibiotics
Do you use anticoagulation treatments for endocarditis?
Nope
Defining symptom of pericarditis
Chest Pain
Defining characteristic of carcinoid syndrome patients
Flushed
The best first test for a potential endocarditis patient
Blood cultures
Which endocarditis patient should get a transesophageal echo?
Ones with a prosthetic valve
Name for the retinal hemorrhages associated with endocarditis?
Roth Spots
Which murmurs increase with inspiration?
Right side of heart
Septic emboli in the lung + IE is associated with
IV drug use
Best step to take for an IE patient following blood cultures?
Start antibiotics
What is Red Man Syndrome? What do you do about it?
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.
Equation for sensitivity
(True Positives) / (TP + False Negatives)
Equation for specificity?
True Positives / (TP+False Positives)
Alcoholic homeless flea bitten people are associated with what infection?
Bartonella
Indications for IE prophylaxis?
Prosthetic Valve Heart Transplant Recipient Previous endocarditis Cyanotic Heart Disease PLUS: Dental Work (w/bleeding) or tonsillectomy.
How do you modify treatment if the infection is in a prosthetic valve?
Add rifampin
