Infective Endocarditis

Question 1

What is infective endocarditis

Answer 1

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

Question 2

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

Answer 2

Mitral valve

Question 3

What valve is the most common site of infective endocarditis in intravenous drug users (IVDU)

Answer 3

Tricuspid

Question 4

Name the two organisms that are implicated in the majority of infective endocarditis cases

Answer 4

Streptococcal and Staphylococcal

Question 5

Name some of the risk factors associated with infective endocarditis

Answer 5

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

Question 6

What is the most common risk factor for infective endocarditis

Answer 6

Previous episode of infective endocarditis

Question 7

What is the causative organisms for infective endocarditis in IVDU

Answer 7

Staph. aureus infection

Question 8

Staphylococcus aureus is the most common organism associated with infective endocarditis.

What patient group is it common in?

Answer 8

IVDUs and prosthetic heart valves

Question 9

Streptococcus viridans is a common organism associated with infective endocarditis.

What patient group is it mostly associated with?

Answer 9

Linked to poor dental hygiene or following a dental procedure

Question 10

What are the two hallmark clinical features of infective endocarditis

Answer 10

Pyrexia and new heart murmur

Question 11

Name the 4 signs associated with infective endocarditis

Answer 11

Janeway lesions

Osler nodes

Roth spots

Splinter haemorrhages

Question 12

What criteria is used to make a diagnosis of infective endocarditis

Answer 12

Modified Duke Criteria

Question 13

What is the diagnostic criteria for infective endocarditis in the modified Duke Criteria

Answer 13

Contains major and minor criteria

IE diagnosis if:

• 2 major criteria
• 1 major + 3 minor criteria
• 5 minor criteria

Question 14

What are the two investigations for infective endocarditis

Answer 14

Echocardiogram (ECHO)

Blood cultures

Question 15

What is the minimum amount of blood cultures required for infective endocarditis

Answer 15

at least 3 sets taken at 30 minute intervals

Question 16

Echocardiography is a gold standard investigation for infective endocarditis.

Name the two types that could be used in infective endocarditis

Answer 16

transthoracic echocardiography (TTE)

Transoesophageal echocardiography (TOE)

Question 17

What is the mainstay of treatment for infective endocarditis

Answer 17

Long term IV antibiotics

Question 18

IV antibiotics is the mainstay of treatment for infective endocarditis.

What is the antibiotic length of course for a patient with native valve endocarditis

Answer 18

4 weeks

Question 19

IV antibiotics is the mainstay of treatment for infective endocarditis.

What is the antibiotic length of course for a patient with prosthetic valve endocarditis

Answer 19

6 weeks

Question 20

What root do you want to give antibiotics in managing infective endocarditis

Answer 20

IV root

Oral is not effective at penetrating the bacterial vegetation

Question 21

Why is PR interval prolongation in a patient with IE an indication for surgery?

Answer 21

As it can be secondary to aortic root abscess

Question 22

Describe the surgery used to treat infective endocarditis

Answer 22

The main aims of surgical repair is:

• Remove infected tissue
• Reconstruction of cardiac anatomy i.e. valve repair or replacement

Question 23

Name the 3 complications of infective endocarditis

Answer 23

Heart failure (most common)

Pericarditis

Embolus e.g., stroke, PE

Question 24

What is the most common complication of infective endocarditis

Answer 24

Heart failure