IE Flashcards
What IE S/S mimics a pneumonia or pleural effusion?
Pulmonary Emboli
MC cause of IE
Turbulent blood flow
Prognosis and relapse facts
W/in 2 months usually
Risks with Prosthetic valves
Continued IVDU
If an IVDU has Left sided organism involvement (S.A.) how do you u TXT?
Surgery (Left sided organisms are bad juju)
Acute IE important S/S
HIGH fever + chills (NEG labs & Dx tests)
Definite IE requirements per DUKE criteria
MAJ 2
MAJ 1 + 3 min
5 min
MIcro-infarct white dots surrounded by hemorrhage found in the eye.
Roth spots
Order of IE valve commons
MV > AV > TV > PV
IVDU - (MC) TV
How long is IE ABX TXT?
4-6 weeks
Subacute - Chronic IE important S/S
LOW fever + non-specific S/S
If a TEE misses IE but there is still a high suspicion what can be done?
RPT TEE 3-5 Days after
Unstable IE pt - how do you TXT?
Admit & empircally TXT after…
-drawing a min 2 blood cx sets over 30-60m
PAINFUL nodules on fingers
Osler Nodes
Immunologic phenomena (Minor Duke Criteria
Conditions required for IE to develop
- Endocardial Injury
- PLT/Fibrin thrombus formation
- Bacteria in circulation adhere
Community associated IE due to what organism
Streptococcal IE
Can a progressing TR cause a pulmonary emboli?
Yes
Possible IE requirements per DUKE criteria
MAJ 1 + 1 Min
3 Min
When to give IE prophylaxis for dental procedures
C- Cardiac transplant
R- Repaired CHD w/ prosthetic materials
U- Unrepaired cynaotic CHD
Emergent indications for surgery
- Refractory Pulmonary edema (12hr diuretic fail)
- Severe regurgitation (AR, MR)
- Cardiogenic shock
If pt is acutely ILL how many blood cultures should be obtained over what time span before you can do what?
3 blood cultures collected
Over a 1hr time span
Before beginning Empiric therapy
Name of criteria used to DX IE
Duke Criteria
Healthcare associated IE due to what organism
Staphylococcal IE
If you have three positive blood cultures of an atypical IE organism would you TXT? If so, how?
Yes, Empircally
Dx of IE requires HCP to
Detailed HX PE BLD Cx Echo (TTE - initial TOC) CXR
Stable IE pt - How do you TXT?
Admit & wait for blood cx before starting ABX
What organisms cause highest mortality?
Fungi and P. Aeruginosa
3 types of acute/subacute IE
- Native valve
- Prosthetic valve
- IVDU related
If you have refractory bacteria >7D how do you TXT?
Surgery
Marantic
non-bacterial thrombotic
The majority of procedures can be covered with what ABX prophylaxis?
Amoxicillin 2g
PAINLESS flat petechiae seen on palm and soles
Janeway Lesions
Vascular phenomena (Minor Duke criteria
Does a increase or change in a pre-existing murmur count towards Major DUKE criteria?
NO - Must be a NEW murmur
Besides DUKE criteria what are pathologic criteria to make a DX of Definite IE?
Histology of lesion - Evidence (Vegetation/Abscess)
Microorganism - ID organism on Direct culture or histology
What are the differences between echocardiogram methodologies for DX IE
TTE - Initial TOC - Large vegetation’s or valve dysfx
TEE - Small vegetation’s, eval prosthetic (more SENS)
Urgent indications for surgery
Any HF
Local infectious complications (fistulas/abscess)
