Infective endocarditis

Question 1

What is infective endocarditis?

Answer 1

infection of inner surface of heart - usually affects abnormal heart valves

rare but 100% fatal without antibiotics

Question 2

Common organisms that cause infective endocarditis

Answer 2

Staph aureus - very acute
Strep viridans (normal oral commensal) - slow process
Strep faecalis (normal gut commensal)

Question 3

What is vegetation in infective endocarditis and what risk does this pose?

Answer 3

collection of organisms and thrombus
embolisation risk

Question 4

Clinical presentation of infective endocarditis

Answer 4

fever
night sweats
malaise
anorexia
weight loss
aches + pains
vasculitic rashes
splinter haemorrhages
murmur (original lesion + valve erosion)
glomerulonephritis
enlarged spleen (very chronic infection)
clubbing (very chronic infection)
Osler’s nodes, Janeway lesions, Roth spots

Question 5

What type of rash is seen in infective endocarditis?

Answer 5

haemorrhagic rash

Question 6

What is a roth spot?

Answer 6

retinal haemorrhages with white or pale centres, commonly associated with subacute bacterial endocarditis and immune complex mediated vasculitis

Question 7

Major complication of infective endocarditis?

Answer 7

systemic embolism (from a vegetation breaking off)

heart failure (due to valve damage)

Question 8

Cerebrovascular complications of infective endocarditis

Answer 8

embolism (less likely after ~1 week of antibiotics)

infected aneurysm (mycotic aneurysm)

Question 9

Diagnosis of infective endocarditis

Answer 9

clinical suspicion
blood cultures (do before antibiotics)
inflammatory markers high (CRP, ESR)
low grade anaemia and mildly raised wbc
echocardiography to image vegetations, valve damage and abscesses - transoesophageal better

Question 10

Endocarditis treatment/management

Answer 10

antibiotics - usually IV 4-6 weeks
‘The Heart Team’ - cardiology/microbiology/cardiac surgery

surgery urgently considered if:
- haemodynamic deterioration due to damage caused by the infection
- infection not responding to antibiotics
- abscess seen on echo
- prosthetic infection

Question 11

Infective endocarditis prevention

Answer 11

antibiotic prophylaxis for procedures where infective endocarditis is a risk when the patient has predisposing heart conditions

good oral hygiene and regular dental review

Question 12

Cardiac conditions with highest risk of infective endocarditis

Answer 12

prosthetic valves
previous IE
congenital heart disease (any cyanotic or other repaired using prosthetic material)