Infectious Endocarditis

Question 1

2 requirements to get IE

Answer 1

Vascular endothelial damage and platelet-fibrin formation

Bacteremia

Question 2

Risk factors for IE

Answer 2

Age > 60
Male
Injection drug users
Poor dentition
Structural heart disease
Prosthetic heart valves and intra cardiac devices
Intravascular catheters or procedures
Chronic hemodialysis
History of endocarditis

Question 3

Is left or right sided IE more common

Answer 3

Left sided

Right is most common in injection drug users

Question 4

Clinical manifestations of IE

Answer 4

Fever
Non-specific: chills, night sweats, anorexia, weight loss, malasie, headache, myalgias, arthralgias
Heart murmur
Vascular phenomenon: petechiae, micro-hemorrhage/abscess
Cerebral emboli (L sided)
Pulmonary emboli (R sided)

Question 5

Major criteria for modified Duke

Answer 5

At least 2 sets of blood cultures positive for typical IE organisms in the absence of a primary focus
Single positive blood culture for Coxiella burnetii or anti-phase 1 IgG antibody titer >1:800
Echo findings consistent with IE

Question 6

Minor modified Duke criteria

Answer 6

Predisposing heart condition or IVDU
Fever > 38
Vascular phenomenon
Immunological phenomenon
Positive blood cultures for typical IE organisms that do not meet major criteria
Positive serology for an organism associated with IE

Question 7

Is TTE or TEE better for IE?

Answer 7

TEE is more sensitive for diagnosing IE

Question 8

Duration of therapy for IE is usually how long?

Answer 8

6 weeks

Question 9

Inoculum effect

Answer 9

High bacterial density of IE

Means B-lactams and vanco are less effective

Question 10

2 types of meds needed to cure IE

Answer 10

B-lactam or Vanco to disrupt cell wall

Aminoglycoside to penetrate and kill bacteria

Question 11

HACEK organisms for culture negative endocarditis

Answer 11

Haemophilus
Aggregatibacter
Cardiobacterium hominis
Eikenella corrodens
Kingella

Question 12

Candida IE

Answer 12

Very high mortality (> 80%)
Absolute contraindication for surgery
Micagungin IV for > 6 weeks
Lifelong fluconazole suppression therapy if no surgery
Eye exam warranted

Question 13

Early surgery for IE is indicated for… (4)

Answer 13

HF unresponsive to medical therapy
Perivalvular extension including new heart block, annular or aortic abscess
Candida or highly resistant organisms

Question 14

Antibiotic used for prophylaxis with dental procedures

Answer 14

Amoxicillin