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CVS (Cardiology) > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

What is Infective Endocarditis?

A

Infection of part of the endocardial surface of a valve.

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2
Q

Risk Factors of Infective Endocarditis (6).

A
  1. Previous Episode.
  2. Rheumatic Valve Disease.
  3. Prosthetic Valves.
  4. Congenital Heart Defects.
  5. IVDUs.
  6. Recent Piercings.
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3
Q

Which valve is most commonly affected generally?

A

Mitral valve.

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4
Q

Which valve is most commonly affected in IVDUs?

A

Tricuspid valve.

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5
Q

Commonest Causative Organisms of infective Endocarditis (4).

A
  1. S. aureus (commonest) - IVDU.
  2. S. viridians (S. minis and S. sanguinis - both associated with poor dental hygiene and dental procedures).
  3. S. bovis (link : colorectal cancer).
  4. S. epidermidis - coagulate negative (< 2 months post-surgery e.g. indwelling lines).
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6
Q

Non-Infective Causes of Endocarditis (2).

A
  1. SLE - Libman-Sacks.
  2. Malignancy - Marantic Endocarditis.
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7
Q

Pathophysiology of Infective Endocarditis (3).

A
  1. Bacteraemia.
  2. Invasion and Adhesion to Valve.
  3. Replication of Pathogens, Enmeshment within Layers of Platelets and Fibrin to Form Vegetations.
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8
Q

What is a Vegetation?

A

Thrombus containing micro-organisms.

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9
Q

Consequences of Endocarditis (3).

A
  1. Disturbance of Valve Function.
  2. Embolism (Septic) and Aneurysm (Mycotic).
  3. Antigen-Antibody Immune Complex Formation.
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10
Q

Clinical Signs of Infective Endocarditis (6).

A
  1. Janeway Lesions - Non-Tender Macules on Palms/Soles.
  2. Osler nodes - Tender Subcutaneous Nodules on Finger Pads/Toes.
  3. Roth Spots - Exudative Haemorrhage Retinal Lesions with Pale Centres.
  4. Microscopic Haematuria (Glomerulonephritis).
  5. Splinter Haemorrhages.
  6. PR Prolongation/Complete AV Block (Aortic Root Abscess).
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11
Q

What combination of signs should raise suspicion of Infective Endocarditis?

A

Fever and New Murmur.

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12
Q

Investigations of Infective Endocarditis (3).

A
  1. 3 Sets of Blood Cultures 1 hour apart from Various Sites.
  2. 1st Line Imaging : Transthoracic Echo.
  3. Most Sensitive : TOE.
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13
Q

Diagnostic Criteria of Infective Endocarditis (4)

A

DUKES :
1. Pathological Criteria -
2. 2 Major Criteria.
3. 1 Major + 3 Minor Criteria.
4. 5 Minor Criteria.

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14
Q

What is Pathological Criteria?

A

Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery.

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15
Q

What are the Major Criteria? (2)

A
  1. Positive Blood Cultures.
  2. Evidence of Endocardial Involvement e.g. Echo or new Regurgitation.
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16
Q

What are the Minor Criteria? (5)

A
  1. Predisposing Heart Condition or IVDU.
  2. Positive Microbiology but does not meet major criteria.
  3. Pyrexia.
  4. Vascular Phenomena.
  5. Immunological Phenomena.
17
Q

Management of Infective Endocarditis (2).

A
  1. Long-Term (Minimum 6 Weeks) IV Antibiotics - initially Broad-Spectrum, but then sensitive.
  2. Surgical Repair.
18
Q

Initial Blind Antibiotic Therapy in Infective Endocarditis (3).

A
  1. Native Valve : Amoxicillin +/- Low-Dose Gentamicin.
  2. Penicillin Allergy, MRSA, Sepsis : Vancomycin + Low-Dose Gentamicin.
  3. Prosthetic Valve : Vancomycin + Rifampicin + Low-Dose Gentamicin.
19
Q

Indications for Surgical Repair in Infective Endocarditis (7).

A
  1. Haemodynamically Unstable.
  2. Severe HF.
  3. Severe Sepsis.
  4. Valvular Obstruction or Infected Prosthetic Valve.
  5. Persistent Bacteraemia.
  6. Repeated Emboli.
  7. Aortic Root Abscess +/- PR Interval Prolongation.
20
Q

When is IE Prophylaxis not required? (4)

A
  1. Dental Procedures.
  2. Upper and Lower GI Procedures.
  3. GU tract procedures.
  4. Upper and Lower Respiratory Tract Procedures.
21
Q

Complications of Infective Endocarditis (4).

A
  1. Acute Valvular Insufficiency - HF.
  2. Neurological Complications e.g. Stroke, Abscess, Haemorrhage.
  3. Embolic Complications.
  4. Infection e.g. Osteomyelitis, Septic Arthritis.
22
Q

Poor Prognostic Factors of Infective Endocarditis (4).

A
  1. S. aureus.
  2. Prosthetic Valve - especially if early.
  3. Culture Negative.
  4. Low Complement.

CVS (Cardiology) (37 decks)

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