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MI Internal Medicine and Infectious Disease > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

Characteristics of endocarditis

A
  1. Fever
  2. Persistent bacteremia
  3. Vegetation on endothelial surface of heart
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2
Q

Characteristics of endocardial vegetation

A
  1. Variable size
  2. Mass made of fibrin and platelets
  3. Lots of microbes
  4. Few inflammatory cells
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3
Q

What are the 4 types of IE?

A
  1. Native valve IE
  2. Prosthetic valve IE
  3. IV drug abuse IE
  4. Nosocomial IE
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4
Q

What classifies acute IE?

A
  1. Affects normal heart valves
  2. Rapidly destructive
  3. Metastatic foci
  4. Most commonly caused by Staph
  5. W/O Tx is fatal within 6 weeks
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5
Q

What classifies subacute IE?

A
  1. Often affects damaged heart valves
  2. Slower progression
  3. W/O Tx is fatal in 1 year
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6
Q

What are the risk factors for IE?

A
  1. IVDU
  2. Artificial heart valves and pacemakers
  3. Acquired heart defects
  4. Congenital heart disease
  5. Intravascular catheters
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7
Q

In general, what are the top 3 major causes of IE?

A
  1. S. aureus
  2. Viridans group (Strep)
  3. CNS
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8
Q

What is the most common cause of culture negative IE?

A

Prior antibiotic therapy

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9
Q

Outline the patho of IE

A
  1. Turbulent blood flow makes the endocardial surface sticky
  2. Bacteremia brings microbes to the sticky surface
  3. These organisms adhere to the endocardial surface
  4. Over time they invade the heart valve leaflets
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10
Q

List the destructive local effects of IE

A
  1. Valve distortion/destruction
  2. Chordal rupture
  3. Perforation
  4. Paravalvular abscess
  5. Conduction abnormalities
  6. Purulent pericarditis
  7. Valve obstruction
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11
Q

Clinical features of IE

A
  1. Fever
  2. Splenomegaly
  3. Heart murmurs
  4. Peripheral signs
  5. Emboli
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12
Q

What are the peripheral signs of IE?

A
  1. Splinter hemorrhage
  2. Oslers nodes
  3. Janeway lesions
  4. Subconjunctival hemorrhage
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13
Q

What are Janeway lesions?

A
  1. Erythematous, blanching macules
  2. Non-painful
  3. Located on palms and soles
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14
Q

Where do you find Roth’s spots?

A

In the eye

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15
Q

What investigations are appropriate for suspected IE?

A
  1. Blood cultures
  2. CBC
  3. CRP
  4. Urinalysis
  5. Renal and hepatic profile
  6. ECG
  7. TTE or TEE
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16
Q

Lab abnormalities associated with IE

A
  1. Anemia
  2. Leukocytosis
  3. Thrombocytopenia
  4. Urinalysis abnormalities
  5. Elevated liver enzymes
  6. Abnormal CSF
17
Q

Which has higher sensitivity, TTE or TEE?

A

TEE (75-95% vs < 60%)

18
Q

What are the indications for TEE?

A
  1. Definite or suspected IE
  2. Persistent bacteremia (5-7 days) with antibiotic Tx
  3. Persistent emboli
  4. Conduction deficits
  5. Pre and peri-operative assessment
  6. S. aureus bacteremia
19
Q

How many blood cultures should be drawn for suspected IE?

A

Somebody please edit, not clear from lecture…

20
Q

What are the 3 categories under the Modified Duke Criteria?

A
  1. Definite
  2. Possible
  3. Rejected
21
Q

What are the pathological criteria for definite IE?

A

Microorganisms - culture/histology in a vegetation/emboli/intracardiac abscess OR

Pathologic lesions - vegetations or intracardiac abscess present, confirmed by histology

22
Q

What are the clinical criteria for definite IE?

A

2 major criteria OR
1 major and 3 minor criteria, OR
5 minor criteria

23
Q

What are the clinical criteria for possible IE?

A

1 major and 1 minor criteria OR

3 minor criteria

24
Q

How might you reject the Dx of IE?

A
  1. Confirmed alternative Dx, OR
  2. Resolution with antibiotics for 4 days or less, OR
  3. No pathological evidence of IE in surgery/autopsy, after antibiotics for 4 days or less
25
Q

What are the major criteria for IE?

A
  1. Positive blood cultures

2. Evidence of endocardial involvement

26
Q

What defines a +ve blood culture for IE?

A
  1. Typical microorganism found from 2 separate blood cultures
  2. Persistently +ve culture
  3. Single +ve culture for coxiella or IgG Ab titre > 1:800
27
Q

What constitutes evidence of endocardial involvement for IE?

A

On echo..

  1. Oscillating intracardiac mass
  2. Abscess
  3. New partial dehiscence of a prosthetic valve

OR - new valve regurgitation

28
Q

What are the minor criteria for IE?

A
  1. Predisposing heart condition or IVDU
  2. Fever (38)
  3. Vascular phenomena (Janeway lesions, splinter hemorrhage)
  4. Immunologic phenomena (glomerulonephritis, Osler’s nodes, Roth spots, etc.)
29
Q

What is the empiric Tx for IE in IVDU?

A

Vancomycin or Daptomycin

30
Q

What is the empiric Tx for native valve IE?

A
  1. Penicillin G or Ampicillin + Cloxacillin + Gentamicin, OR

2. Vancomycin + Gentimycin

31
Q

What is the empiric Tx for prosthetic valve IE?

A
  1. Vancomycin + Gentamicin + Rifampicin
32
Q

IE is associated with a high mortality, T or F?

A

True

33
Q

What is endocarditis?

A

An infection of the endocardial surface of the heart

MI Internal Medicine and Infectious Disease (35 decks)

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