IE and RHD Flashcards
What is infective endocarditis?
Inflammation of the endocardium, usually involving the valves.
Characterised by vegetations (platelets, fibrin, and microorganisms).
What are the signs of IE?
Systemic - PE, MI, infarction, immune response.
Heart murmur, embolic complications, splinter haemorrhages, Osler’s nodes, Janeway lesions.
What are the symptoms of IE?
Fever, chills, rigors, poor appetite, weight loss.
Myalgia, abdominal/back pain, confusion.
What are the risk factors of IE?
Prosthetic valves, pacemakers, defibrillators.
IVDU, CHD, rheumatic valve disease, MV prolapse, immunosuppression, prolonged admission to hospital.
What investigations of the blood are done in IE?
High CRP and WBCs, erythrocyte sedimentation, anaemia, microscopic haematuria.
3 sets of bloods, 30 minutes apart (before abx).
What are the different microorganisms that can cause IE?
S. Aureus, Streptococci, Enterococci, coagulase negative staphylococci, Haemophilus, Aggregatibacter, Cardiobacterium, Eikenelly, Kingella.
If negative for IE - Brucella, Coxiella burnetti, Bartonella, Tropheryma whipplei, Mycoplasma, Legionella, Fungi.
Non-infective (SLE - Libman-Sacks endocarditis; autoimmune diseases - Marantic endocarditis).
What are the investigations for IE?
TTE - vegetations, abscesses, broken valve.
TOE - if TTE is negative, but high suspicion; or positive TTE, to rule out complications.
CT/MRI - detection of embolic events.
PET - if diagnosis is unclear, detects peripheral embolic events.
ECHO - valve regurgitation, systolic functions.
What are the Modified Duke’s Criteria?
Major - positive blood culture typical of IE, valvular vegetations on ECHO.
Minor - cardiac lesions, IVDU, febrile, embolic or immunologic phenomena, positive blood culture that is atypical of IE.
Definite IE - 2 major / 1 major, 3 minor / 5 minor.
Possible IE - 1 major, 1 minor / 3 minor.
What is the prognosis of IE?
Complications include HF, ischaemic stroke, shock, renal failure.
What is the treatment for prosthetic valves?
Rifampicin + Gentamicin (6wks).
Ampicillin + Flucloxacillin + Gentamicin (all valves).
Vancomycin + Gentamycin (if allergic to penicillin).
What are the indications for cardiac surgery?
HF with valvular dysfunction or cardiac complications.
Uncontrolled infection (persistent fever, positive bloods).
Embolism prevention (large vegetation, embolic episodes).
What is rheumatic heart disease?
Very common in low/middle income countries.
Group A beta-haemolytic Strep infection (S. Pharyngitis) for 2-3wks leads to rheumatic fever (pericarditis, valvulitis, painful joints). After years of this, RHD develops.
What are the symptoms and investigations for RHD?
Symptoms - SOB and fatigue.
Investigations - ECG, CXR, ECHO (typically the mitral valve - chordal rupture, dilation, leaflet prolapse, nodular tips).
What is the diagnosis of RHD?
Subclinical - ECHO positive, but clinically silent.
Asymptomatic - audible murmurs.
Develops into symptomatic and advanced.
What is the treatment for RHD?
Secondary prevention - penicillin prophylaxis.
Diuretics, ACEis/ARBs (vasodilators), BBs/Digoxin/Warfarin (AF).
Balloon mitral valvuloplasty - for symptomatic MS, younger patients, and pregnant.
Cardiac surgery - when valvuloplasty is not possible (repair or replacement), for severe MR.
