Infective Endocarditis Flashcards
What is infective endocarditis
Refers to an infection of the endocardial surface of the heart i.e. the innermost lining
Characterised by the formation of vegetations on cardiac valves
Infections of the endocardium may involve one or more heart valves (both prosthetic and native).
What heart valvue is the most common site of infective endocarditis
Mitral valve
What valve is the most common site of infective endocarditis in intravenous drug users (IVDU)
Tricuspid
Name the two organisms that are implicated in the majority of infective endocarditis cases
Streptococcal and Staphylococcal
Name some of the risk factors associated with infective endocarditis
Previous episode of infective endocarditis [most common]
Age > 60
Male sex
IVDU - predisposition to Staph. aureus infection and right-sided valve disease e.g. tricuspid endocarditis
Dental procedure
Poor dentition and dental infections
Congenital heart disease
Immunosuppression e.g. HIV
What is the most common risk factor for infective endocarditis
Previous episode of infective endocarditis
What is the causative organisms for infective endocarditis in IVDU
Staph. aureus infection
Staphylococcus aureus is the most common organism associated with infective endocarditis.
What patient group is it common in?
IVDUs and prosthetic heart valves
Streptococcus viridans is a common organism associated with infective endocarditis.
What patient group is it mostly associated with?
Linked to poor dental hygiene or following a dental procedure
What are the two hallmark clinical features of infective endocarditis
Pyrexia and new heart murmur
Name the 4 signs associated with infective endocarditis
Janeway lesions
Osler nodes
Roth spots
Splinter haemorrhages
What criteria is used to make a diagnosis of infective endocarditis
Modified Duke Criteria
What is the diagnostic criteria for infective endocarditis in the modified Duke Criteria
Contains major and minor criteria
IE diagnosis if:
- 2 major criteria
- 1 major + 3 minor criteria
- 5 minor criteria
What are the two investigations for infective endocarditis
Echocardiogram (ECHO)
Blood cultures
What is the minimum amount of blood cultures required for infective endocarditis
at least 3 sets taken at 30 minute intervals
Echocardiography is a gold standard investigation for infective endocarditis.
Name the two types that could be used in infective endocarditis
transthoracic echocardiography (TTE)
Transoesophageal echocardiography (TOE)
What is the mainstay of treatment for infective endocarditis
Long term IV antibiotics
IV antibiotics is the mainstay of treatment for infective endocarditis.
What is the antibiotic length of course for a patient with native valve endocarditis
4 weeks
IV antibiotics is the mainstay of treatment for infective endocarditis.
What is the antibiotic length of course for a patient with prosthetic valve endocarditis
6 weeks
What root do you want to give antibiotics in managing infective endocarditis
IV root
Oral is not effective at penetrating the bacterial vegetation
Why is PR interval prolongation in a patient with IE an indication for surgery?
As it can be secondary to aortic root abscess
Describe the surgery used to treat infective endocarditis
The main aims of surgical repair is:
- Remove infected tissue
- Reconstruction of cardiac anatomy i.e. valve repair or replacement
Name the 3 complications of infective endocarditis
Heart failure (most common)
Pericarditis
Embolus e.g., stroke, PE
What is the most common complication of infective endocarditis
Heart failure
