Infective endocarditis

Question 1

What is infective endocarditis?

Answer 1

Condition caused by infection of the endocardium of the heart

Question 2

What structure is most commonly affected by infective endocarditis?

Answer 2

The mitral valve

Question 3

What is the most common bacterial cause of infective endocarditis?

Answer 3

Staphylococcus aureus

Question 4

What is the most common cause of infective endocarditis in developing countries?

Answer 4

Streptococcus viridians

Question 5

What are risk factors for infective endocarditis?

Answer 5

rheumatic valve disease
prosthetic valves
congenital heart defects
intravenous drug users

Question 6

How is infective endocarditis diagnosed?

Answer 6

Via the Modified Duke criteria

Question 7

What is the Modified Dukes criteria?

Answer 7

Infective endocarditis diagnosed if
pathological criteria positive, or
2 major criteria, or
1 major and 3 minor criteria, or
5 minor criteria

Question 8

What are the pathological criteria for the diagnosis of infective endocarditis?

Answer 8

Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery

Question 9

What are the major criteria for the diagnosis of infective endocarditis?

Answer 9

Positive blood cultures more than 12 hours apart

Evidence of endocardial involvement

Question 10

What are the minor criteria for the diagnosis of infective endocarditis

Answer 10

predisposing heart condition
Intravenous drug use
fever > 38ºC
vascular phenomena:
immunological phenomena

Question 11

What are examples of endocardial involvement that are suggestive of infective endocarditis?

Answer 11

Positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation or dehiscence of prosthetic valves), or
New valvular regurgitation

Question 12

Which valve is typically affected in IV drug users affected by infective endocarditis?

Answer 12

Tricuspid valve

Question 13

What are the 2 main signs that would suggest infective endocarditis?

Answer 13

A new murmur AND a fever

Question 14

What is the first line imaging investivgation (and most sensitive)`for infective endocarditis?

Answer 14

Transthoracic echocardiogram

Question 15

What might you find on an echocardiogram that would suggest Infective emdocarditis?

Answer 15

Vegetation
Abscess
Partial dehiscence of prosthetic valve
New valvular regurgitation

Question 16

What is the management of infective endocarditis?

Answer 16

Long term IV antibiotic therapy

Question 17

How long shoudl antibiotics be given for infective endocarditis?

Answer 17

Minimum 6 weeks

Question 18

What antibiotics can be given initially if it is a native valve before the infective cause is diagnosed?

Answer 18

Amoxicillin +/-low-dose gentamicin

If penicillin allergic
vancomycin + low-dose gentamicin

Question 19

What antibiotics can be given initially if it is a prosthetic valve before the infective cause is diagnosed?

Answer 19

vancomycin + rifampicin + low-dose gentamicin

Question 20

What is the management of Native valve endocarditis caused by staphylococci?

Answer 20

Flucloxacillin

Vancomyin and rifampicin if penicillin allergic

Question 21

What is the management of Prosthetic valve endocarditis caused by staphylococci?

Answer 21

Flucloxacillin + rifampicin + low-dose gentamicin

vancomycin + rifampicin + low-dose gentamicin

Question 22

What are indications for the surgical management off infective endocarditis?

Answer 22

severe valvular incompetence
aortic abscess (often indicated by a lengthening PR interval)
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy

Question 23

What vascular phenomena are included in the minor criteria infective endocarditis?

Answer 23

Major emboli
Splenomegaly
Clubbing
Splinter haemorrhages
Janeway lesions
Petechiae
Purpura

Question 24

What immunological phenomena are included in the minor criteria for infective endocarditis?

Answer 24

Glomerulonephritis
Osler’s nodes
Roth spots