Infective Endocarditis Flashcards
what is infective endocarditis
infection of the endovascular structures in the heart
organsims causing it and timings
staph epidermis <2months post valve surgery
staph aureus
risk factors
IV drug user valvular disease prosthetic valves previous infection HIV infection rheumatic heart disease
symptoms and signs
fever, pleuritic pain, night sweats, fatigue, weight loss
Janeways lesions Osler nodes Splinter haemorrhages Roth spots microscopic haematuria, glomerulonephritis
investigations
three separate blood cultures, different time and location echocardiogram trans-oesophageal echocardiogram bloods CXR
Dukes criteria
major:
1 - two separate positive cultures for the organisms
2 - image from echo correlates with diagnosis
minor: 1 - risk factor 2 - fever 3 - vascular sign 4 - microbiological - positive culture but not for desired organism 5 - immunological phenomena
2 major
3 minor + 1 major
5 minor
management
broad spectrum antibiotics
surgery:
haemodynamic instability
PR prolongation (aortic dissection)
sepsis
what would be seen on the echocardiogram
vegetation of a valve
when should you suspect IE
fever and murmur
what antibiotics are uses
first line:
amoxicillin/vancomycin
flucloxacillin and gentamicin - positive cocci in clusters
benzylepenicllin and gentamicin - positive cocci in chains
what other high suspicions should you have if a patient presents with IE
colon cancer
PR bleeding/abdomen pain
organism causing it - strep bovis
when would you do prophylaxis
gastrointestinal or genitourinary procedure
patients have an infection from other causes
what valves are commonly affected
mitral valve
tricuspid valve - IV drug users
