infective endocarditis Flashcards
what is infective endocarditis?
microbial infection of heart valve, and lining of chamber
predisposing factors?
rheumatic heart disease
congenital heart defect
prosthetic heart valve
causative organisms?
strep viridans: dental extraction
enterococcus fecalis: older women with genitourinary infection
strep bovis: associated with large bowel ca
staph aureus: skin infection, iv drug users
staph albus: post operative endocarditis
fungal infections: immunocompromised
non infective causes?
old age malignancy dic uremia burns sle
what is vegetations?
mass which is composed of fibrins, platelets, and infecting organisms known as vegetation
how embolism occur?
peice of large vegetation broken and infarct the other organs like spleen, pulmonary embolism, gut, kidney etc
types?
subacute: affecting in rheumatic pt and congenital heart defect patient, common organism is viridans
acute: highly virulent and invasive organism like staph aureus
prosthetic: common aureus and epidermis
clinical features?
fever lasted for 2 weeks(may be absent in older age with CCF CRF)
petechiae roth spot on retina
splenomegaly in long standing cases
janeway lesion: non tender macules on palmar and plantar surfaces
splinter heamoraheg
osler nodes: painful subcutaneous nodules at fingertip
typical murmur of endocarditis?
character of murmur change with change of vegetation size
investigation?
blood culture cbc crp echo( tee is 90 sensitive) ecg chest xray urine serology
causes of negative blood culture?
fungal infection
organism required special media like legoniella
slow growing organism
antibiotic before culture
diagnosis criteria?
major: two + culture persistent +culture single + for coxiella burnetti evidence of endocardial involvement(abcess, dehiscence of valve, vegetation on valve) development of murmur minor: predisposing factor, fever, vascular phenomena, osler nodes roth spots micorbiological evidence echo +
definitive and possible endocarditis?
two major or one major + 3 minor or five minor
one major + one minor or 3 minor
indications for surgery?
acute heart failure failure of antibiotic for more than 1 weeks fungal infection persistent + culture gram negative organisms large vegetation first or second degree heart block
