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z year3 cardio conditions > Infective endocarditis > Flashcards

Infective endocarditis Flashcards

1
Q

What are risk factors for infective endocarditis?

A
  1. Acquired valvular heart disease with stenosis or regurgitation
  2. Hypertrophic cardiomyopathy
  3. Previous IE
  4. Use of IV drug
  5. Recent vascular access (e.g. peripheral venous cannula)
  6. Recent dental work
  7. Structural congenital heart disease
  8. Valve replacement or implantation of a cardiac device
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2
Q

What are the signs and symptoms of infective endocarditis?

A
  1. Fever/chills
  2. Cardiac murmur
  3. Night sweats, malaise, fatigue anorexia, weight loss, myalgias
  4. Weakness
  5. Arthralgias
  6. Headache
  7. SOB
  8. Meningeal signs
  9. Janeway lesions
  10. Osler nodes
  11. Roth spots
  12. Splinter haemorrhages
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3
Q

What are some differential diagnosis for infective endocarditis?

A
  1. Rheumatic fever
  2. Atrial myxoma
  3. Libman-Sacks endocarditis
  4. Non-bacterial thrombotic endocarditis
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4
Q

What bloods do you order for infective endocarditis?

A
  1. Blood cultures
  2. FBC
  3. CRP
  4. Serum urea, electrolytes and glucose
  5. LFTs
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5
Q

What imaging do you do for IE?

A
  1. Echocardiography (transthor before oeso unless indicated)
  2. ECG
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6
Q

What other tests would you do for IE?

A

urinalysis

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7
Q

How do you take blood cultures is IE?

A

three sets of blood cultures from different venepuncture sites taken at 30 min interval before initiation of antibiotic therapy

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8
Q

What would the FBC show in IE?

A

normocytic, normochromic anaemia and 1/3 have leucocytosis with neutrophilia

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9
Q

What is the CRP like in IE?

A

raised

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10
Q

Why do you do serum urea, electrolytes, glucose and LFTs for IE?

A

show baseline

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11
Q

What may you see in echo for IE?

A

valvular, mobile vegetations

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12
Q

What could an ECG show in IE?

A
  • can have conduction abnormalities secondary to IE
    1. prolonged PR interval
    2. non-specific ST/T wave abnormalities
    3. AV block
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13
Q

Why do you do a urinalysis and what may you see for IE?

A
  • can show septic emboli (complication of IE)
    1. microscopic haematuria
    2. RBC casts
    3. WBC casts
    4. proteinuria
    5. pyuria
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14
Q

What is the 1st line treatment for initial suspected infective endocarditis?

A
  • 1st line: supportive care
  • Plus: empirical broad-spectrum antibiotic therapy
  • Consider: surgery
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15
Q

What is the first line treatment for acute (native valve and prosthetic valve) confirmed IE?

A
  • 1st line: Correct antibiotics: e.g. beta-lactam/vancomycin/amoxicillin/gentamicin or consult with infectious disease or microbiology
  • Consider: surgery
  • High dose 6 weeks - IV
  • Follow up blood cultures
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16
Q

What is the treatment for ongoing at high risk or IE?

A

1st line: advice ± antibiotic prophylaxis

17
Q

What are possible complications from IE?

A
  1. Acute heart failure
  2. Systemic embolization (including stroke)
  3. AKI
  4. Anterior mitral valve vegetation >10mm
  5. Valvular dehiscence, rupture or fistula
  6. Splenic abscess
  7. Mycotic aneurysms
18
Q

What is the prognosis of IE like?

A
  1. 50% require surgery
  2. 20% in hospital mortality
  3. 15% recurrence at 2 years
19
Q

What criteria is used for IE?

A

duke criteria (major and minor)

20
Q

What bacteria usually causes native valve endocarditis?

A
  1. staph.aureus
  2. vividans strep.
    - seen mostly in IV drug
21
Q

What bacteria usually causes prosthetic valve endocarditis?

A
  1. Staph.aureus (MRSA)
22
Q

What are different type of streptococci than can cause IE?

A
  1. S. viridans
  2. Group D streptococci
  3. Streptococcus intermedius
  4. Group A, C and G streptococci
  5. Group B streptococci
23
Q

When is S viridans common?

A
  1. 50-60% of subacute IE cases

2. part of the normal dental flora, hence associated with dental procedures)

24
Q

When is Group D streptococci common?

A

usually subacute and the third most common cause of IE

25
Q

When is streptoccoccus intermedius common?

A
  • acute and subacute infection

- causes 15% of all cases of IE

26
Q

When is Group A, C and G streptococci common?

A
  1. acute IE is similar to that with S. aureus

2. High mortality (up to 70%).

27
Q

When is Group B streptococci common?

A
  1. acute disease, high mortality often requiring valve replacement
  2. occurs in pregnancy and the elderly particularly.
28
Q

What are other rarer causative organisms of IE?

A
  1. Enterococci – Nosocomial UTI’s. Gut + urogenital flora
  2. HACEK organisms (Haemophilus spp.,Aggregatibacter actinomycetemcomitans, Cardiobacterium spp., Eikenella corrodens, Kingella kingae): usually subacute disease and about 5% of all IE.
  3. Pseudomonas aeruginosa: usually causes acute IE and requires surgery for cure
  4. Coxiella Burnetii Is very hard to culture.
29
Q

What is the frequency of the valves affected in IE?

A

mitral>aortic>tricuspid>pulmonary

30
Q

What valve is affected for IV drug users?

A

tricuspid valve is the most commonly affected valve in IV drug users (associated with Pseudomonas, S. aureus, and Candida).

31
Q

How do you collect blood samples for IE?

A

blue (aerobic) blood culture bottle should be filled first, then the purple (anaerobic) bottle

32
Q

Why does the blood need to be collected in this order?

A
  1. as the butterfly tubing may contain air

2. air entering the purple bottle will impede the growth of anaerobic organisms

33
Q

What is the 1st line Ix for IE?

A

TTE (transthoracic echo) and TEE (transeosophageal echo) - TEE is more invasive and TTE is 1st line unless complication e.g. prosthetic valve

34
Q

When are antibitocis given in IE?

A
  1. Empirical antibiotics (After blood samples taken unless haemodynamically unstable)
  2. Targeted antibiotics after sensitivity results (2-6 weeks)
35
Q

What additional treatment is given in IE for prosthetic valves?

A

prosthetic valve endocarditis, anticoagulation may be required to prevent stroke/PE

36
Q

What antibiotics are given for staphyloccocus?

A

flucloxaccilin

37
Q

What antibiotics are given for staphyloccocus?

A

flucloxaccilin

38
Q

What antibtioics are given for MRSA?

A

Vancomycin/gentamycin

39
Q

What antibtioics are given for prosthetic valves?

A
  1. Staphylococci = Flucloxacillin/Vancomycin + rifampicin + gentamicin
  2. CONCEPT = MORE AGGRESSIVE ANTIBIOTIC THERAPY IN PROSTHETIC

z year3 cardio conditions (22 decks)

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