Infective Endicarditis Flashcards
Pathophysiology of infective endocarditis?
Becteraemia with bacterial lodging in damaged endocardium, most commonly an infected valve. The valve becomes inflamed, eroded, and a vegetation develops
Causes?
Dental procedures, invasive investigations
Which bacteria is usually responsible?
Step. Viridans is most common but others such as staph. a and chlamydia may be responsible
How does acute endocarditis present?
Acute febrile Illness, ischeamia in toes and fingers, changing murmurs and valve incompetence
Presentation of subacute endocarditis?
Longer illness, intermittent fever, sweats, malaise, weight loss, splinter haemorrhages (caused by circulating immune complexes), changing murmur, finger clubbing, Roth spots (retinal haemorrhages with pale centres), janeway lesions, café au lait spots
Duke criteria are used for diagnosis, how many need to be met?
Two major, one major and 3 minor or 5 minor
Major criteria include?
+ve blood culture for a causative bacteria in inf endocarditis evidence of vegiatation or new regurgitation on echocardiogram
Minor criteria are?
Predisposing heart problem, persisting fever over 38 degrees, vascular phenomenon (splinter hs), immunological (Roth spots), +ve blood culture for a non assoc bacteria! consistant echo
Investigations include?
Multiple blood cultures from different sites and times, FBC (low Hb high WBC), raised CRP and ESR, echo (vegiatation a or regurg), ECG
If haemodynaiclly unstable where are patients kept
HDU
What is the management?
Key is identification of organism and antibiotics against it. Burst guess antibiotics are benzyl penicillin and gentamicin at least 3 weeks IV but therapy as a whole at least 6 weeks
What surgery may have to be done if there is valve damage?
Valve replacement
What is it?
An infection of the endocardium, the layer that which covers the valves and the lining of the cardiac chambers
