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Cardiovascular system > Infectious diseases of heart > Flashcards

Infectious diseases of heart Flashcards

1
Q

What is infective endocarditis?

A

It is infection of the inner endocardium, it affects valves, septa, chordae tendinea, intra-cardiac devices

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2
Q

What is the prognosis for patients with endocarditis ?

A

The prognosis is poor, the mortality is high

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3
Q

What are the non-cardiac risk factors for infective endocarditis?

A

IV drug use, immunocompromised, AIDS, diabetes mellitus, chronic skin conditions, GI infections. or manipulations, GI lesions, pregnancy, abortion, alcoholic cirrhosis, solid organ transplant, body lice, pneumonia, meningitis, cat exposure, indwelling medical devices

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4
Q

What are the cardiac risk factors for infective endocarditis ?

A

mitral valve prolapse and regurgitation, ventricular septal defect, aortic stenosis and regurgitation, rheumatic heart disease, prosthetic heart valve, cardiac surgery, prior IE, congenital heart defects, intra-cardiac devices, invasion procedures to heart

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5
Q

What part of heart is more affected by IV drug use?

A

The right side of the heart

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6
Q

What is the initial step in infective endocarditis?

A

mechanical disruption of valve endothelium

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7
Q

What are the causes of the mechanical disruption of endothelium of valves?

A

It can be caused by turbulent flow called the Venturi effect, electrodes, catheters, rheumatoid carditis, degenerative changes, but if the endothelium is physically normal there is local inflammation

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8
Q

What is Venturi effect?

A

It describes how pressure and velocity changes as blood flows through constriction, in has high pressure and low velocity, then as it enters the constriction there is low pressure but high velocity and the back again to low velocity and high pressure,

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9
Q

What is the second stage in infective endocarditis?

A

Formation of sterile thrombus, it is formed on damaged endothelium, it consists of fibrin-platelet network, adherence and invasion of the thrombus

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10
Q

What is the third set in the infective endocarditis ?

A

There must be bacteraemia in the blood, invasion of bacteria into the sterile thrombus

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11
Q

What can cause bacteraemia?

A

Invasive procedures especially GI, oral, abdominal, genitourinary interventions and surgeries, intravascular catheters, gingival disease, can be also caused by brushing teeth

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12
Q

What is the classification of IE based on duration?

A

acute, subacute, chronic

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13
Q

Which organism is associated with acute infection?

A

Staph aureus

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14
Q

Which organism is associated with subacute infection?

A

Streptococcus

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15
Q

What is the classification of IE based on the location?

A

left-sided native valve, left side prosthetic valve, right sided, device related such as PPM permanent pacemaker, ICD implantable cardioverter defibrillator

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16
Q

What is classification based on the mode of acquisition?

A

healthcare related (nosocomial, non-nosocomial), community acquired, IVDA (IV drug abuser)

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17
Q

What are the symptoms of IE?

A

fever of unknown origin, fatigue, malaise, other possible symtoms are weight loss, headache, muscoskeletal pain

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18
Q

What are the signs of IE?

A

splinter haemorrhages, vasculitis rash, Roth spots,, Oslers nodes, Janeway lesions, new murmur, bacterium, can also have congestive heart failure, embolic phenomena signs

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19
Q

What is Roth spot?

A

retinal haemorrhage, has white or pale centre

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20
Q

What are Osler’s nodes?

A

deep, red spots that are painful, raised, usually on finger pulls, palms and sores

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21
Q

What are Janeway lesions?

A

flat, macular, ecchymotic spots, they are non-tender, on palms, soles

22
Q

When can be the signs absent?

A

in elderly patients, after antibiotic treatment, in immunocompromised, if the organism is less virulent or atypical

23
Q

What investigations are performed for IE diagnosis?

A

Bloods (FBC, CPR, U+E), blood cultures that are taken from 3 different sites and are 6 hours apart, if the patient os very unwell 2 sets in 1 hour, ECG, chest X ray, urinalysis, ECHO

24
Q

What are the two types of ECHO that can be performed for IE?

A

transthoracic TTE and transoesophageal TOE

25
Q

What is the fist line imaging?

A

TTE, if nothing detected and the clinical suspicion is low no TOE, if it is normal but the clinical suspicion is high do TOE, if both are negative but the clinical suspicion remains high need to repeat the test after 7-10 days, if TTE is positive to TOE to measure size of vegetation, abscess and any complications

26
Q

In what scenario do the ECHOS need to be repeated?

A

If new complications arise, such as new murmur, resisting fever, embolism, heart failure, abscess, AV block, in immunocompromised patients, to assess success of the treatment

27
Q

Name the scenarios when the blood cultures can be negative

A

It previously on antibiotics, it can be negative for few days, or for fastidious organism, or intracellular bacteria

28
Q

What are the most commonly involved microorganisms in IE?

A

Staphylococcus, Enteroccoci, Streptococci

29
Q

What are the streptococci organisms that are involved in IE?

A

There are 4 groups, oral viridans, milleri, nutritionally variant defective, group D (associated with GI), such as bovis

30
Q

What are the enterococci that are involved in IE ?

A

faecalis, faecium, durans

31
Q

What are the Staphylococci organisms that are involved in IE?

A

aureus -healthcare related, coagulase negative epidermis that is healthcare associated

32
Q

In which patients is Staph more likely?

A

In IV drug abusers, or patients with prosthetics

33
Q

In which patients are Strept more likely?

A

In patients with prosthetic material more than year after implantation

34
Q

Which fastidious organisms are involved in IE?

A

HACEK, Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella, also Brucella, fungi

35
Q

What intracellular organisms can be associated with IE?

A

Coxiella burnetti, Bartonella, Chlamydia, for detection they need serology, PCR, cell culture

36
Q

How is IE diagnosed?

A

Based on Duke criteria, the definite diagnosis is if there are 2 major, 1 major and 3 minor or 5 minor ,

37
Q

What are the major criteria?

A

positive blood culture, ECHO or new murmur

38
Q

What are the minor criteria?

A

predispostion, fever, immunological phenomenal such as Oslers nodes, Roth spots, rheumatoid factor, glomerulonephritis, vascular phenomena such as haemorrhages, emboli, infects, Janeway lesions, splinter haemorrhage, ongoing infection

39
Q

What factors need to be taken into account when deciding about the treatment ?

A

previous use, local resistance, previous surgery, prosthetic material

40
Q

When should the treatment for IE be started ?

A

Straight after the cultures have been obtained, changes can be done after the organism has been identified

41
Q

What is the treatment for native valves?

A

IV gentamicin and IV amoxycillin, use IV vancomycin in penicillin resistant patients or suspicion of MRSA

42
Q

What is the treatment procedure in native valves and sepsis?

A

In gentamicin and IV vancomys=cin

43
Q

What organisms are associated with native valves?

A

Staph, Strep, HACEK, bartonella

44
Q

What is the treatment if prosthetic valves are present?

A

gentamicin, IV vancomycin and rifampicin

45
Q

What are the organism associated with prosthetic valves?

A

MRSA, MSSA, non HACEK gram negative,

46
Q

What is the necessary follow up during the antibiotic treatment ?

A

bloods daily, ECG every 1-2 days, ECHO weekly

47
Q

What organisms are associated with fungal IE ?

A

Candida, aspergillus

48
Q

In which type if patients is fungal IE more likely?

A

In immunocompromised

49
Q

What are the complications of IE?

A

heart failure with pulmonary oedema, fistula formation, leaflet perforation, uncontrolled infection with persistent fever, uncontrolled local infection, adverse reaction to treatment, embolic complications, resistant or wrong organism detected, infected central lines, abscess formation, AV heart block, prosthetic valve dysfunction

50
Q

What is the other option of treatment of IE?

A

Surgery to replace the valves

51
Q

What is the prophylaxis?

A

Antibiotic use is not recommended any more, good oral care, care should be taken invasive procedures

Cardiovascular system (18 decks)

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