Infective endocarditis Flashcards
Pathogenesis of infective endocarditis
Non-bacterial thrombotic endocarditis (NBTE) —> microbes in blood stream —> vegetation at site of NBTE
Valves affected the most in IE
Site of turbulent flow: mitral & aortic
Most common bacteria
Viridans streptococcal
Bacteria found in IV drug use
staph aureus
Does s aureus has a higher or lower virulence than viridans streptococcal
Higher
Where is viridans strep found
Mouth
Where is s aureus found
Skin
Which bacteria can attack both healthy and previously damaged valves
S aureus
Does s aureus cause smaller or larger vegetations than viridans strep
Larger
Which bacteria destroys the valve it vegetates at
Staph aureus
Which bacteria is attracted to prosthetic valves
Staph epidermis
Where are enterococcus faecalis & strep bovids found
Normal gut flora
Why is there a new heart murmur in IE
Turbulent flow past damaged valve
What is the underlying cause of splinter haemorrhages & janeway lesions
Septic emboli (detached vegetations)
What is the underlying cause of osler’s nodes, Roth spots, glomerulonephrosis
Immune reactions —> antigen-antibody complexes
What is the diagnostic triad in pericarditis
1- chest pain
2- friction rub on auscultation
3- ECG: diffuse ST elevation; PR depression
Location of chest pain in pericarditis and myocarditis
- reterosternal
- left-sterna
Radiation of chest pain in pericarditis
Neck
Character of chest pain in pericarditis
- pleuritic
- positional (worse when flat)
Exacerbating factors of chest pain in pericarditis
- coughing
- swallowing
Character of chest pain in myocarditis, when can it be similar to pericarditis
- nonpleuritic, nonpositional
- myopercardiotitis
Cardiac tamponade Beck’s tirade
- hypotension
- distended JV
- muffled H sound
An exam question is likely to describe endocarditis organisms as
gram positive cocci
