Infective Ednocarditis

Question 1

What is infective endocarditis?

Answer 1

Microbial infection of the endocardial surface of the heart, vegetations precipitate on the heart, valves, mural endocardium, chordae tendinae. More likely to percipitate on a heart defect , eg septal defect
Bacterium can go into patients blood

Question 2

Things that predispose IE?

Answer 2

• transient bacteraemia; occurs when a heavily colonized mucosal surface is traumatized
  Example: central line at ICU or dialysis or insertion of venous catheter
  Dental extraction due to exposed blood vessel, periodontal surgery, tooth brushing in presence of gingival inflammation
• abnormal tissue , eg VHD,RHD,CHD , valve replacement , cardiomyopathy and previous episodes of endocarditis

Question 3

Process on endocarditis?

Answer 3

-organism (strep) beyhawto el valve or in the heart causing white blood cells , inflammatory cells , fibrin yeego and all together make a mobile structure called vegetation
- it may cause regurgitation due to its size and prevent the valve from fully closing
Nb. More likely to percipitate on the left side since it has higher pressure

Question 4

Criteria for diagnosing infective endocarditis?

Answer 4

Modified duke criteria; 2 major, 1 major + 3 minore or 5 minor
- major
1. Positive blood culture
2. Eco showing evidence of vegetation on the endocardium
- minor
1. Predisposing heart disease
2. IV drug abuser ( only occasion where there’s right side vegetation, impurities -> vena cava -> right atrium )
3. Vascular phenomena (septic embolism hatroh heta tania fel body w y manifest)
4. Arterial embolism: vegetation dislodge and cause embolus

Question 5

Complications of endocarditis?

Answer 5

Cardiac; congestive heart failure, valvular damage or vegetation may cause a hole in valve and cause acute heart failure
Non cardiac;
- embolisation
- stroke
Risk decreases 2when there is antimicrobial treatment
- deterioration 3am lel patients dih

Question 6

Vascular phenomena? (Look at picture)

Answer 6

Dissemination of infection can cause:
- osler’s nodules; tender papulppustules
- Jane way lesion; macular, non tender, erythematous on the palm of the hand
- petechiae on oral mucosa , skin , conjunctivae (red macules keda)
- splinter haemorrhages: linear red lesion in nail bed

Question 7

What is therapy needed for infective endocarditis?

Answer 7

1. Anticoagulant: only reasonable to discontinue if patient with mechanical valve and IE had a CNS embolism event (for 2 weeks)
2. Antiplatelet
3. Ampicillin-sulbactam 12g/day IV in 4 doses for 4-6 weeks
   Or amoxicillin- clavulanate (12 g/day IV in 4 doses) with gentamicin (3 mg/kg/day i.v or i.m in 2 or 3 doses) for 4-6 weeks
   Note: vancomycin should be substituted for penicillin if theres high resistance or allergy

Question 8

Prophylaxis for IE?

Answer 8

• Oral amoxicillin 2g for adults
• if allergic to penicillin to ampicillin
  Give oral cephalexin (2 g) or clindamycin (600 mg) or azithromycin or calrithromycin (500 mg)