Infective Endocarditis Flashcards by Shadekiel Kassie

What is infective endocarditis?

This is a microbal infection of the heart valves, lining of the heart chamber and the blood vessels.

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What is the incidence of Infective Endocarditis?

5-15 cases per 100,000 per annum

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What percentage of IE patients are over 60yrs?

> 50%

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What percentage of pesons with Rheumatic Fever develop IE

24%

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What percentage of persons with congenital heart disease develops IE

19%

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What is the fatality rate of bacterial endocarditis

20%
(increased in prosthetic valves)
(increased in anti-biotic resistant organisms)

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List 7 groups of aetiological agents that can cause Infective Endocarditis

Oral Cavity Commensals
Bowel or Urinary Tract Commensals
Skin Commensals 
Post operative
Q Fever Endocarditis
HACEK Group
Yeast and Fungi

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Oral Commensals account for what percentage of IE cases (subacute IE that is)

75%

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What group of oral commensal cause Subacute IE

Viridans Streptococci

Strep. Mitis

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List 3 groups of bowel, urinary commensals that can cause Infective Endocarditis

Enterococcus Faecalis
E.Faecium
Strep. Bovis

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In the event that a patient is found to have IE secondary to Strep. Bovis ( Strep. Gallolyticus) what investigation is important to be done?

Colonoscopy, as the patient is likely to have a large bowel malignancy

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What is the most common cause (organism) of Acute Endocarditis

Staphylococcus Aureus

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List 1 skin commensal that can cause IE (acute)

Staphylococcus Aureus

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How does a skin commensal like Staph aureus get into the blood steam to cause IE?

Abscess
Vascular access sites
Skin infections

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Apart from Staph. Aureus list 2 other causative agents of Acute Infective Endocarditis

Strep. pneumoniae

Strep. Pyogenes

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What group of bacteria is usually the source of Infective endocarditis secondary to operation (post-op commensals)

Coagulase negative staphylococcus

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List two examples of Coagulase Negative Staphylococcus

Staph. Epidermis

Staph. Lugdenesis

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A patient that has a h/o conatct with farm animals, most likely has what type of infective endocarditis

Q Fever Endocarditis

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Which bacteria causes Q Fever Endocarditis

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Coxiella Bumetii

What is the treatment for Q Fever Endocarditis

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Lifelong antibiotics

List the “slow growing, fastdidious, gram negative organisms, oropharyngeal commensals” that can cause Infective Endocarditis

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HACEK Group
H- Haemophillus Aphrophilus
A- Aggregatibacter Actino.
C- Cardiobacterium Hominis
E- Eikenella Corrodens
K- Kigella Kingae

List 2 yeast/ fungi that can cause infective endocarditis

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Candida
Aspergillus
(in dwelling catheters)

List the 4 steps in the pathogenesis of infective endocarditis

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1) Occurs at Site of Endothelial damage
2) Avascular Valve protects microb from WBCs
3) Vegetations may grow and cause obstruction or embolize
4) Adjacent tissue destroyed, abscess may form

Why does the infection in IE usually occur at sites of endothelial damage ?

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Because they attract deposits of platelets and fibrin that are vulnerable to colonization by microbs

List 5 complications of IE

``` Valve Regurgitation Skin lesions Vasculitis Mycotic Aneurysm Infarct of kidney or spleen ```

What is the difference between acute and subacute Infective Endocarditis

Acute endocarditis can develop suddenly and become life-threatening within days while subacute endocarditis develops slowly over a period of several weeks or months

What are the 4 factors that determine the presentation of IE

- subacute/acute IE - Causative agent - Site of infection - presence of valve shunt or prosthesis

Subacute Endocarditis should be suspected in a patient with Congenital Heart disease, or valvular heart disease when they experience which symptoms?

- Night Sweats - Persistent Fever - Weight Loss - Unusual Tiredness - night sweats - new signs of valve dysfuction

Subacute Endocarditis should be suspected in a patient with Congenital Heart disease, or valvular heart disease when they experience which signs?

``` Splinter Haemorrhage Purpura Petechial haemorrhage Osler's nodes digital clubbing ```

What is the difference between osler's nodes and janeway lesions

Osler's nodes are painful tender swellings at the fingertips while janeway lesions are rare non-tender macules on the palms and soles

List three signs/symptoms of acute endocarditis

severe febrile illness prominent changing heart murmurs petechiae

What are the signs of post operative IE

unexplained fever in a patient who has had heart valve surgery

List three differentials for infective endocarditis

``` Lyme Disease Atrial Myoxma (non cancerous tumour) Antiphospholipid Syndrome (mistakenly attack body tissue) ```

List 5 investigations done for a pt with IE

``` Blood culture ECG Echocardiogram ESR/CRP CXR ```

How is misdignosis of skin commensals avoided when taking blood cultures for IE?

Blood culutres taken from 2/3 different sites at 3 hr intervals. NB// Both aerobic and anaerobic culture required

what are three main reasons for doing an Echo in a pt with IE

- detecting and following the progress of vegetations - detect abscess - assess valve damage

List two types of Echo

Transesophageal (90% sensitivity) | Transthoracic (65% sensitivity)

Which is better in assessing abscess formation and in pts with prosthetic valves, Transoesophageal or transthoracic Echocardiography?

Transesophageal

True or False | Faluire to detect vegetations does not exclude diagnosis

True

In infective Endocarditis, what might an ECG reading show?

May show the development of an AV block

What is the empirical treatment for Subacute Infective Endocarditis?

amoxicillin (2g 6times daily IV) | +/- Gentamicin

What is the empirical treatment for Acute Infective Endocarditis?

Vancomycin (1g bd IV) + gentamicin (1mg/kg bd IV) +Rifampicin (300-600 mg po)

What is the empirical treatment for Infective Endocarditis caused by Enterococcus?

Amoxicillin + Gentamicin If pen allergic: vancomycin + gentamicin —for 4wks (6wks if prosthetic valve); review need for gentamicin after 2wks.

List 5 indications for cardiac surgery in a patient with infective endocarditis

Heart Failure due to valve damage Failure of antibiotic therapy Large vegetations on left sided heart valves (high risk of emboli) Previous evidence of systemic emboli Abscess formation

What is the criteria for diagnosis of infective endocarditis?

Duke's Modified Criteria - 2 major - 5 minor - 1 major , 3 minor

DUKE'S MODIFIED CRITERIA | List 5 major criteria.

- Typical organism (Staph, Strep) from 2 cultures - Persistent positive blood culture >24hrs - 3+ positive cultures taken over 1hr - Positive echo findings of vegetations - New valvular regurgitation

DUKE'S MODIFIED CRITERIA | List 7 minor criteria.

- Predisposing valvular and cardiac abnormality - Pyrexia >38oC - Blood cultures suggestive but may not meet major criteria - Embolic Phenomenon - Vasculitis phenomenon - IV drug misuse - suggestive echo findings

Infective Endocarditis Flashcards

(47 cards)