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Clinical Medicine - Cardiology > Infectious Endocarditis > Flashcards

Infectious Endocarditis Flashcards

1
Q

What two symptoms should make you think endocarditis?

A

Fever

Murmur

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2
Q

What are risk factors for infective endocarditis?

A

prosthetic valve
IV drug use

Poor dental hygiene
Hemodialysis
Indwelling catheters
Diabetes mellitus

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3
Q

What is infective endocarditis?

A

Microbial infection of the endocardium of the heart

Inner lining of the heart
Chordae Tendinae
Valves

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4
Q

What organisms cause IE?

A

Staph aureus (Gram +, slow clearing)

Coagulase neg Staph (early prosthetic valve IE)

Steptococi

  • mutans
  • sanguis
  • bovis (elderly)
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5
Q

HACEK IE stands for …

A 
Haemophillus
Actinobacillus
Cardiobacterium hominis
Eikenella
Kingella kingae
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6
Q

Major criteria for IE

A
  1. Laboratory Evidence of IE
    2+ blood cultures
    1+ blood culture - Coxiella burnetti
  2. Endocardial involvement - TTE/TEE
  3. New valvular regurgitation
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7
Q

Minor criteria for IE

A
  1. Predisposing heart condition
  2. Fever
  3. Valvular phonmenon
    • emboli (JL), mycotic aneurysm, hemorrhages
  4. Immunologic phenomenon
    • GN, Osler’s nodes, RH factor
  5. Positive blood culture - not a major
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8
Q

How is IE diagnosed?

A

2 Major
1 Major + 3 Minor
5 Minor

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9
Q 
What is an Osler Node?
Size and shape?
Course?
Types of endocarditis its seen with?
Culture?
Histology?
A

Painful, swollen, subQ nodule on the pulp of the fingers and toes

1 mm to > 1 cm
Hours to days
Subacute
Negative culture, usually
Vasculitis
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10
Q

What is a Janeway Lesion?

Size and shape?
Course?
Types of endocarditis its seen with?
Culture?
Histology?
A

Non-tender nodule on the palms or soles

Macules of variable size and irregular shape
Days to weeks
Acute
Positive culture, usually
Septic microemboli
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11
Q

What are the signs and symptoms of IE?

A 
Fever
Weight loss
Fatigue
Heart failure
Night sweats
Heart murmur
Splenomegaly
Skin petechiae
Conjuctival hemorrhage
Splinter hemorrhage
Septic shock
Osler nodes
Janeway lesions
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12
Q

What is the treatment of IE? What things do you have to consider?

A

Is it G+?
PCN sensitive?
Yes - PCN or Ampicillin + Aminoglycoside
No - Vancomycin + Aminoglycoside

2-6 weeks IV antibiotics

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13
Q

Should we anti coagulate someone with IE?

A

NO

  • doesn’t prevent embolism
  • may increase risk of bleeding
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14
Q

What is the best first test in someone with suspected IE?

A

Blood cultures

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15
Q

What finding would you see on the optic disk in someone with IE?

What finding on external eye exam?

A

Roth spots

Subconjuctival petechiea

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16
Q

What finding would you see on the nails of someone with IE?

A

Splinter hemorrhage

17
Q

What type of murmurs are usually seen with IE?

A

Regurgitant murmurs

–bacteria eats at valve

18
Q

What is the number one reason to operate on a heart valve?

A

Valve rupture

19
Q

What murmur presents as a holosystolic murmur?

A

Mitral regurgitation

20
Q

What murmurs increase with inspiration?

Decrease?

A

R sided murmurs increase with inspiration

L sided murmurs decrease with inspiration

21
Q

What findings might you see on a chest X-ray of someone with with IE?

A

Infectious cavitary lesions

These are seen when there is also tricuspid regurgitation

22
Q

After performing the blood cultures, what is the next best step?

A

Start antibiotics

Best empiric choice is vancomycin and gentamicin

If cultures grow sensitive Staph aureus, switch vancomycin to nafcillin

23
Q

If after starting vancomycin and gentamicin, the patient develops redness and flushing at the neck line, what should you do?

A

Decrease the rate of infusion of the AB

24
Q

Strep bovis endocarditis is also associated with …

A

lesions in the colon

Should perform colonoscopy

“when you say bovis, I say buttocks”

25
Q

What is different with the diagnosis/initial management of a patient with suspected IE and a prosthetic heart valve?

A

Go straight to TEE

  • more things to look for and harder to see with TTE
  • look for dehiscence, abscesses, and vegitations
26
Q

Homeless man, alcoholic, flea bitten. Fever and murmur. Blood cultures negative. Echo shows vegetation. Diagnosed by PCR. Which organism?

A

Bartonella

Trench fever!

27
Q

What are indications for prophylaxis to prevent IE?

A

Prosthetic valve
Heart transplant recipient
Previous endocarditis
Uncorrected cyanotic heart disease

PLUS
Dental work with bleeding –> i.e. extraction
Tonsillectomy/Adenoidectomy

28
Q

When are some examples of times that prophylaxis is not needed for IE?

A

GI procedures
GU procedures
Fillings

29
Q

TTE vs TEE - testing value

A

TEE more sensitive

Usually try TTE first though

Clinical Medicine - Cardiology (11 decks)

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