Infective Endocarditis

Question 1

The analogous process involvingarteriovenous shunts, arterio-arterial shunts (patent ductus arteriosus),or a coarctation of the aorta is called

Answer 1

infective endarteritis

Question 2

is a hectically febrile illness that rapidly damages cardiac structures, seeds extracardiac sites, and, if untreated, progresses to death within weeks.

Answer 2

Acute endocarditis

Question 3

follows an indolent course;
causes structural cardiac damage only slowly, if at all; rarely metastasizes; and is gradually progressive unless complicated by a major embolic event or a ruptured mycotic aneurysm

Answer 3

Subacute endocarditis

Question 4

The risk of PVE is greatest during the first____ after valve replacement; gradually declines to a low, stable-rate thereafter; and is similar for mechanical and bioprosthetic devices.

Answer 4

6–12 months

Question 5

Injection drug use–associated endocarditis, especially that involving the tricuspid valve, is commonly caused by____ which in manycases is resistant to methicillin. Left-sided valve infections in addictshave a more varied etiology

Answer 5

S. aureus,

Question 6

PVE arising within 2 months of valve surgery—i.e., early PVE—is generally nosocomial and is the result of intraoperative contamination of the prosthesis or a bacteremic postoperative complication. This nosocomial origin is reflected in the primary microbial causes:

Answer 6

S. aureus
CoNS (coagulase-negativestaphylococci)
facultative gram-negative bacilli
diphtheroids
and fungi

Question 7

TRue or false

HIV infection in drugusers does not significantly influence the causes of endocarditis.

Answer 7

True

Question 8

Endothelial injury (e.g., at the site of impact of high-velocity blood jets or on the low-pressure side of a cardiac structural lesion) allows either direct infection by virulent organisms or the development of a platelet–fibrin thrombus—a condition called

Answer 8

nonbacterial thrombotic endocarditis (NBTE)

Question 9

nonbacterial thrombotic endocarditis (NBTE)
also arises as a result of a hypercoagulable state;
this phenomenon gives rise to____ (uninfected vegetations seen in patients with malignancy and chronic diseases) and to bland vegetations complicating systemic lupus erythematosus and antiphospholipid antibody syndrome.

Answer 9

marantic endocarditis

Question 10

The classic nonsuppurative peripheral manifestations of SUBACUTE endocarditis are related to prolonged infection; with early diagnosisand treatment, these have become infrequent.

Answer 10

Janeway lesions

Question 11

In contrast, septic embolization mimicking some of these lesions is common in patients with ACUTE S. aureus endocarditis

Answer 11

subungual hemorrhage

Osler’s nodes

Question 12

are focal dilations of arteries occurring at points in the artery wall that have been weakened by infection in the vasa vasorum or where septic emboli have lodged

Answer 12

Mycotic aneurysms

Question 13

Almost 50% of endocarditis associated with injection drug use is limited to the ____ valve and presents with fever but with faint or nomurmur and no peripheral manifestations.

Answer 13

tricuspid

Question 14

Blood cultures:

In patients with suspected NVE, PVE, or CIED endocarditis who have not received antibiotics during the prior 2 weeks

Answer 14

three 2-bottle blood culture sets, separated from one another by at least 2 h, should be obtained from different venipuncture sites over 24 h.

Question 15

What Single positive blood culture is a major criterion for IE

Answer 15

Coxiella burnetii or

phase I IgG antibodytiter of >1:800

Question 16

is the optimal method for the diagnosis of PVE andCIED endocarditis as well as for the detection of myocardial abscess,valve perforations, or intracardiac fistulae

Answer 16

TEE

Question 17

Use for E. faecalis isolates with or without high-levelresistance to gentamicin and streptomycin or for patientsat high risk for aminoglycoside nephrotoxicity (creatinineclearance rate <50 mL/min; see text).

Answer 17

Ampicillin (2 g IV q4h) plus ceftriaxone (2 g IV q12h) both for 6 weeks

Question 18

is the major indication for cardiac surgery

Answer 18

Moderate to severe refractory CHF caused by new or worsening valve dysfunction or intracardiac fistulae

Question 19

This complication, is the most common Perivalvular Infection and occurs in 10–15% of patients with NVE and in 45–60% of those with PVE.

Answer 19

aortic valve infection

Question 20

is the test of choice to detect perivalvular abscesses(sensitivity, ≥85%).

Answer 20

TEE with color Doppler

Question 21

Surgical treatment is also advised for endocarditis caused by organisms against which effective antimicrobial therapy is lacking (e.g.,

Answer 21

yeasts
fungi
P. aeruginosa
other highly antibiotic-resistant bacteria,Brucella species).

Question 22

True or false:

Surgical treatment should be considered for patients with MRSA left-sided NVE who remain septic and unresponsive to alternative antibiotics.

Answer 22

True

Question 23

True or false

Isolated tricuspid-valve S. aureus endocarditis, even with persistent fever, rarely requires surgery.

Answer 23

True