Infective Endocarditis Flashcards
what is infective endocarditis
Infective endocarditis (IE) is an infection involving the endocardial surface of the heart, including the valvular structures, the chordae tendineae, sites of septal defects, or the mural endocardium
what parts of the heart does Infective endocarditis affect
endocardial surface of the heart,
valves
the chordae tendinae,
sites of septal defects
main causative agents of infective endocarditis
streptococcus viridans
staphylococcus aureus
enterococci
what can bacteraemia lead to
platelet aggregation and clot formation
what type of symptoms does infective endocarditis present with
embolism and fever
risk factors of infective endocarditis
abnormal heart valves
turbulent blood flow
recent dental work/ hygiene
IV drug use - right sided endocarditis due to S. aureus
presenting symptoms of infective endocarditis
fever with sweating/chills
malaise
night sweats
weakness
arthralgia,
headache,
shortness of breath
signs of infective endocarditis on physical examination
pyrexia, tachycardia, anaemia, clubbing, murmurs (mitral most common)
splenomegaly
what vasculitic lesions will be present in patients with infective endocarditis
Janeway lesions (on palms, blanch on pressure)
oslers nodes (toe/finger pads)
splinter haemorrhages
Roth spots on retina
investigations for infective endocarditis
blood cultures,
echocardiogram
FBC,
urea and electrolytes
LFTs
urine analysis
ECG
summary of investigation findings
Bloods
FBC - high neutrophils, normocytic anaemia
High ESR/CRP
U&Es
NOTE: a lot of patients with infective endocarditis tend to be rheumatoid factor positive
Urinalysis
Microscopic haematuria
Proteinuria
Blood Culture
Do microscopy and sensitivities as well
Echocardiography
Transthoracic or transoesophageal (produces better image)
Duke’s Classification - a method of diagnosing infective endocarditis based on the findings of the investigations and the symptoms/signs
management of infective endocarditis
Antibiotics for 4-6 weeks
On clinical suspicion = EMPIRICAL TREATMENT
Benzylpenicillin
Gentamicin
Streptococci - continue the same as above
Staphylococci
Flucloxacillin/vancomycin
Gentamicin
Enterococci Ampicillin Gentamicin Culture Negative Vancomycin Gentamicin
SURGERY - urgent valve replacement may be needed if there is a poor response to antibiotics
