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4th Year Cardiology > Infective endocarditis > Flashcards

Infective endocarditis Flashcards

1
Q

Symptoms of infective endocarditis

A
  • Fever
  • Headache
  • Shortness of breath
  • Constitutional symptoms
  • Joint pain: may be due to septic emboli
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2
Q

Signs of infective endocarditis

A
  • Heart murmur +/- evidence of heart failure
  • Janeway lesions: painless plaques on hands and soles
  • Osler’s nodes: painful nodules on fingers or toes
  • Roth’s spots: white centered retinal haemorrhages
  • Splinter haemorrhages
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3
Q

Causes of Janeway lesions, splinter haemorrhage and Osler’s nodes

A
  • Janeway lesions: painless septic microemboli (in palms and soles)
  • Splinter haemorrhages: septic microemboli
  • Osler’s nodes: painful deposition of immune complexes (in fingers and toes)
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4
Q

Differentials of infective endocarditis

A
  • Non-bacterial thrombotic endocarditis
  • Rheumatic fever
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5
Q

Which valve is most commonly affected inn infective endocarditis?

Which valve is most commonly infected in infective endoarditis in intravenous drug users?

A

Mitral valve

Tricuspid valve

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6
Q

Common organisms which cause infective endocarditis

A
  • Staphylococcus aureus
    • Commenest overal
    • IVDU and prosthetic heart valve
    • High mortality
  • Streptococci viridans
    • Second most common
    • Subacute endocarditis
    • Native valve
  • Staphylococcus epidermidis
    • Indwelling
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7
Q

Infective endocarditis: blood cultures are negative, what may be the cause?

A

HACEK

Haemophilus

Aggregatibacter

Cardiobacterium

Eikenella

Kingella

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8
Q

Pathophysiology of infective endocarditis

A
  • Endothelium of valvular structures is damaged (eg turbulent blood flow)
  • Platlet and fibrin adhere to the damaged surface
  • Thrombus formation
  • Bacterial colonisation of the thrombus
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9
Q

What are the classifications of infective endocarditis?

A
  • Native valve endocarditis
    • Strep viridans, enterococcus or stapylococci
  • Prosthetic valve endocarditis
    • Early: S. aureus
    • Late: Streptococci
  • Right sided endocarditis
    • Occurs in IVDU due to S. aureus
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10
Q

Investigations for infective endocarditis

A
  • Bedside
    • ECG: increased PR interval indicates aortic root abscess
    • Urinalysis: microscopic haematuria (caused by septic emboli)
  • Bloods
    • Inflamatory markers: neutrophilia with raised CRP and ESR
    • Blood cultures: 3 separate samples at least 1 hour apart, ideally taken from different sites
    • U&Es: evidence of septic embolus causing glomerulonephritis and renal failure
  • Imaging
    • CXR: evidence of heart failure
    • Echo: transthoracic often conducted first but transoesophageal has a higher sensitivity (90%)
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11
Q

Which criteria is used to diagnose infective endocarditis?

A

Modified Duke Criteria

2 major criteria / 1 major criteria and 3 minor criteria / 5 minor criteria

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12
Q

What are the major criteria on the Modified Duke Criteria ?

A
  • Two positive blood cutures
  • Endocardial involvement of echo
    • Endocardial vegetation
    • Perivalvular abscess
    • New dehiscence of prosthetic valve
    • New valvular regurgitation
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13
Q

Minor criteria of the Modified Duke Criteria

A
  • Predisposing heart condition or IVDU
  • Fever >38 degrees
  • Immunological phenomenon (eg glomerulonephritis, Roth’s spots, Osler’s nodes)
  • Microbiological evidence (positive culture not meeting major criteria)
  • Vascular abnormalities (eg arterial emboli, septic emboli, pulmonary infarct)
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14
Q

Management of infective endocarditis

A

IV antibiotics: typically 4-6 weeks

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15
Q

Empirical antibiotics for infective endocarditis

Native valve

Prosthetic valve

A
  • Native valve: amoxicillin +/- gentamicin
  • Prostheitc valve: vancomycin + gentamicin + rifampicin
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16
Q

Antibiotics for infective endocarditis caused by staphylococci

Native valve (+/- MRSA)

Prosthetic valve (+/- MRSA)

A
  • Native valve: Flucloxacillin
  • Native valve (MRSA): Vancomycin + rifampicin
  • Prosthetic valve: Flucloxacillin + rifampicin + gentamicin
  • Prosthetic valve (MRSA): Vancomycin + gentamicin + rifampicin
17
Q

Antibiotic used for infective endocarditis caused by streptococci (native valve)

A

Benzylpenicillin with or without gentamicin

18
Q

Antibiotic used for infective endocarditis caused by enterococci

A

Amoxicillin

19
Q

Antibiotic used for infective endocarditis caused by HACEK bacteria

A

Ceftriaxone, with or without gentamicin

20
Q

Indications for surgery in infective endocarditis

A
  • Decompensated heart failure caused by infected endocarditis
  • Failed antibiotic therapy
  • Severe sepsis
  • Valvular abscess
  • Intracardiac fistulae
  • Prosthetic valve endocarditis

4th Year Cardiology (12 decks)

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