Infectious Endocarditis - Dubin Flashcards
Fever, decreased breath sounds, heart murmur at R sternal border (decrescendo-diastolic), IV drug user, frequent STIs, elevated sed rate, high WBCs, positive PPD. Nodular infiltrates b/l on x-ray.
R-sided infectious endocarditis (via IV drug use)
Cause of nodular infiltrates
Septic emboli via tricuspid valve
CD4
PCP pneumonia
Most likely organism of R-sided infectious endocarditis
Staph. aureus
Acute vs. subacute bacterial endocarditis
Subacute = L side, slow onset, systemic symptoms, STREP Acute = R side, fast onset, lung symptoms, STAPH
5 predispositions to infective endocarditis
- Prosthetic valves
- Implantable devices
- Parenteral nutrition tube
- Congenital heart disease
- Previous endocarditis
Night sweats are characteristic of ____
TB
Clues on physical exam to endocarditis
NEW murmur or CHANGING murmur
Lab findings common w/ L-sided endocarditis
Anemia (more likely to be chronic), Hematuria
Increased sed rate - meaning
Some immunologic/inflammatory process is occurring
Classic manifestations of infective endocarditis (5)
- Osler nodes (painful, pads of fingers and toes)
- Janeway lesions (painless, palms and soles)
- Slit hemorrhages (under nail beds)
- Roth spots (retinal infarcts, center is pale)
- Conjunctival hemorrhages
Dental procedure –> ___-sided endocarditis
Organism?
Left
Strep (viridans)
Lower bowel or prostate surgery –> endocarditis
Organism?
Enterococcus fecalis
Major Jones Criteria for Acute Rheumatic Fever (5)
- Carditis
- Polyarthritis
- Sydenham’s Chorea
- Erythema marginatum
- Subcutaneous nodules
Minor Jones Criteria for Acute Rheumatic Fever (5)
- Fever
- Arthralga
- Previous rheumatic fever or heart disease
- Acute phase reactants
- Prolonged P-R interval on EKG
Evidences of previous strep. infection (4)
- ASO or other antibodies
- Throat culture for group A
- Group A carb. antigen test
- Recent scarlet fever
IV drugs, shortness of breath, heroin, systolic murmur at lower R sternal border, faint crackles in lungs, no other findings. Treated w/ antibiotics. Next step in management?
Echocardiogram (trans-esophageal if possible)
Q fever - organism and source
- Coxiella burnetti
- Aerosolized animal fluids
- Obligate intracellular proteobacteria
- Dairy, cattle, sheep, goats
Acute Q fever - presentation
Headache, fever, joint pain, GI issues, atypical pneumonia
Chronic Q fever - issue?
Endocarditis
Diagnosis of Q fever
Serologic PCR
When to give prophylactic antibiotics for endocarditis?
- Prosthetic valve, previous endocarditis, Ht transplant, congenital defects)
AND
- Going for dental procedure, tonsillectomy, adenoidectomy, or surgery on infected skin
Standard prophylactic medication
If allergic to penicillin?
Amoxicillin
Clindamycin
Most common gram negative endocarditis (besides in IV drug users)
HACEK organisms (Haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)
Culture-negative endocarditis
HACEK organisms
Treatments for gram positive endocarditis
Strep - Penicillin G
Staph - Nafcillin
3 main causes of myocarditis
- Coxsackie viruses
- Trypanosomes (Chaga’s disease)
- Borrelia (Lyme disease)
Retrosternal chest pain that radiates to neck and L shoulder, cough and difficulty swallowing, night sweats, positive PPD, elevated CBC
Acute pericarditis - secondary to TB
Persistent ST elevation in all leads
Pericarditis
Most common infectious cause of pericarditis
Coxsackie viruses, many others
