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Cardiology > Infective endocarditis > Flashcards

Infective endocarditis Flashcards

1
Q

What is infective endocarditis?

A

Infection of endovascular structures of the heart

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2
Q

What is the strongest RF for developing infective endocarditis?

A

Previous infection of endocarditis

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3
Q

What are the other possible risk factors for infective endocarditis?

A

previously normal valves
rheumatic valve disease (30%)
prosthetic valves
congenital heart defects
intravenous drug users (IVDUs

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4
Q

Which valve is most commonly affected in those with previously normal valves?

A

The mitral valve

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5
Q

Which valve is most commonly affected in IVDU’s?

A

Tricuspid valve

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6
Q

What is the most common cause of infective endocarditis in the developed world?

A

Staphylococcus aureus

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7
Q

What is the most common cause of infective endocarditis in the developing world?

A

Streptococcus viridans

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8
Q

What is the most common cause of infective endocarditis in those who’ve recently had prosthetic valve surgery?

A

Staphylococcus epidermidis-
commonly colonize indwelling lines

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9
Q

How is infective endocarditis diagnosed?

A

Via the Modified Duke’s criteria

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10
Q

How is infective endocarditis diagnosed via the modified dukes criteria?

A

pathological criteria positive, or
2 major criteria, or
1 major and 3 minor criteria, or
5 minor criteria

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11
Q

What is a positive pathological criteria which would confirm infective endocarditis?

A

Positive histology or microbiology of pathological material

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12
Q

What are the major criteria to confirm a diagnosis of infective endocarditis?

A

Positive blood cultures
Evidence of endocardial involvement

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13
Q

What blood cultures would confirm infective endocarditis?

A

Two positive blood cultures showing organisms consistent with IE

persistent bacteraemia from two blood cultures taken > 12 hours apart

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14
Q

What evidence of endocardial involvement would confirms infective endocarditis?

A

positive echocardiogram
new valvular regurgitation

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15
Q

What are the minor criteria that could indicate infective endocarditis?

A

predisposing heart condition or intravenous drug use
microbiological evidence does not meet major criteria
fever > 38ºC
vascular phenomena
immunological phenomena

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16
Q

What vascular phenomena is part of the minor criteria for the diagnosis of infective endocarditis?

A

Major emboli
Splenomegaly
Clubbing
Splinter haemorrhages
Janeway lesions
Petechiae or purpura

17
Q

What immunological phenomena is part of the minor criteria for the diagnosis of infective endocarditis?

A

Glomerulonephritis
Osler’s nodes
Roth spots

18
Q

What are the possible clinical signs of infective endocarditis?

A

Janeway lesions
Osler nodes
Roth spots
Microscopic haematuria Glomerulonephritis
Splinter haemorrhages

19
Q

What are Janeway lesions?

A

Nontender macules on palms and soles

20
Q

What are Osler nodes?

A

Tender subcutaneous nodules on the finger pads and toes

21
Q

What are Roth spots?

A

Exudative haemorrhagic retinal lesions with pale centres

22
Q

What are the 2 main signs that would indicate infective endocarditis?

A

Fever and a new murmur

23
Q

What is the management of infective endocarditis?

A

IV antibiotics for 6 weeks (minimum)

24
Q

What is the management of infective endocarditis of a native valve caused by staphylococci?

A

Flucloxacillin

If penicillin allergic or MRSA
vancomycin + rifampicin

25
Q

What is the management of infective endocarditis of the Prosthetic valve caused by staphylococci?

A

Flucloxacillin + rifampicin + low-dose gentamicin

If penicillin allergic or MRSA
vancomycin + rifampicin + low-dose gentamicin

26
Q

What is the management of infective endocarditis caused by fully-sensitive streptococci (e.g. viridans)?

A

Benzylpenicillin

If penicillin allergic
vancomycin + low-dose gentamicin

27
Q

What is the most likely cause if the patient is an IVDU drug user?

A

Staph aureus

28
Q

What is the most common cause if the patient has recently had a dental proceedure or as poor dental hygiene?

A

Streptococcus viridans

29
Q

What is the most common cause if the patient has previously undergone prosthetic valve surgery?

A

Staphylococcus epidermis

Cardiology (66 decks)

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