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Human Diseases > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

95% of cases of infective endocarditis affect which side of the heart?

A

Left

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2
Q

Is infective endocarditis common or rare?

A

Rare

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3
Q

Is acute infective endocarditis more prevalent on normal or abnormal valves?

A

Equally prevalent

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4
Q

Define infective endocarditis

A

A disease resulting from infection of a focal area of the endocardium

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5
Q

Where does infective endocarditis affect?

A

Heart valves

Chordae tendinae

Site of congenital heart defect

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6
Q

What is the pathogenesis of infective endocarditis?

A

Bacteraemia

Erosion on endocardium

Implantation on endocardium

Vegetations

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7
Q

What are 10 systematic complications of infective endocarditis?

A

Pyrexia

Weight loss

Malaise

Chronic anaemia

Splenomegaly

Finger clubbing

Haematuria

Osler’s nodes

Janeway lesion

Splinter haemorrhage

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8
Q

What are some local cardiac features of infective endocarditis?

A

Arrhythmias

Heart murmur

Heart failure

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9
Q

How to diagnose infective endocarditis?

A

Clinical features examination

Blood cultures

Imaging

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10
Q

What should be included in the general examination of infective endocarditis?

A

Pale face/pallor

Pyrexia

Arrhythmia

Skin lesions

Sub-conjunctival haemorrhages

Unilateral blindness

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11
Q

What are the major Duke criteria for infective endocarditis?

A

Blood cultures positive for IE

Typical microorganisms consistent with IE

Evidence of endocardial involvement

Echocardiogram positive

Vegetation

Abscess

New partial dehiscence of prosthetic valve

New valvular regurgitation

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12
Q

What are the minor Duke criteria for infective endocarditis?

A

Predisposing heart condition

Injection drug use

Fever 38oC

Vascular phenomena eg major arterial emboli

Immunologic phenomena eg Osler’s nodes

Microbiological evidence: positive blood culture

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13
Q

Diagnosis of infective endocarditis is definite if:

A

2 major Duke criteria

1 major and 3 minor Duke criteria

5 minor Duke criteria

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14
Q

Diagnosis of infective endocarditis is possible if:

A

1 major and 1 minor Duke criteria

3 minor Duke criteria

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15
Q

How to treat infective endocarditis?

A

Antimicrobial treatment/antibiotics

Surgery for infected prosthetic heart valve

Management and prevention of complications eg drainage of myocardial abscess

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16
Q

Is antibiotic prophylaxis against infective endocarditis routinely recommended in dentistry?

A

No

17
Q

Which risk groups of patients undergoing bacteraemia-producing dental procedures may be offered antibiotic prophylaxis?

A

High and medium

18
Q

Indications of patients at high risk of infective endocarditis according to SDCEP:

A

Previous infective endocarditis

Any form of prosthetic heart valve/prosthetic material used in valve or congenital heart disease repair

Any type of cyanotic congenital heart disease

19
Q

Indications of patients at moderate risk of infective endocarditis according to SDCEP:

A

Previous history of rheumatic fever

Valvular heart disease

Unrepaired congenital defects of the heart valves

20
Q

What should be covered during antibiotic prophylaxis discussion with high risk IE patients?

A

Explanation of what IE is (infection of the lining of the heart, often involving the heart valves, caused mainly by bacteria which enter the blood from outside the body)

Explanation that due to their heart condition/previous episode of IE, there is a small risk of developing IE following an invasive dental procedure which may increase the chances of bacteria entering the bloodstream

Benefits and risks of antibiotic prophylaxis

Importance of maintaining good oral health to prevent infective endocarditis

Symptoms that may indicate IE and when to seek expert advice

Risks of undergoing invasive procedures such as body piercing or tattooing

21
Q

What are some risk factors for developing infective endocarditis?

A

Congenital lesions such as ventricular septal defect, tetralogy of Fallot, coarctation of aorta and patent ductus arteriosus

Vascular abnormalities such as rheumatic involvement of any valve, bicuspid or calcific aortic valve, sub-aortic stenosis, mitral valve prolapse

IV drug abuse

Abortion

Prosthetic valve

Cardiac/urinary catheterisation

Any invasive diagnostic or surgical procedure

Damage secondary to rheumatic fever

22
Q

Right-sided endocarditis:

  • Incidence
  • Predisposing factors
  • Affected area
A
  • 5% of cases
  • IV drug abusers or immunosuppressed
  • Tricuspid valve
23
Q

What is the prevalence and average mortality rate of infective endocarditis?

A

1-10 per 100,000 people (still increasing)

Twice as common in men than in women

Average mortality rate of 20% (higher in patients >65 y/o; 0.1% of all cardiac deaths)

24
Q

Where is bacterial endocarditis most common in?

A

Damaged valves

Elderly patients

25
Q

What are the common causes of bacterial endocarditis?

A

Oral and faecal streptococci (35%)

Staphylococci (50.5%)

26
Q

Which bacteria is the acute form of bacterial endocarditis most commonly caused by?

A

Staphylococcus aureus (MRSA)

27
Q

What other bacteria are indicated in 5% of endocarditis? (HACEK)

A

Haemophilus

Actinobacillus actinomycetemcomitans

Cardiobacterium hominis

Eikenella corrodens

Kingella spp

28
Q

What fungi could be indicated in 1% of endocarditis?

A

Candida

Aspergillus

29
Q

How does pathogenesis affect prognosis of infective endocarditis in terms of mortality?

  1. Oral streptococci
  2. Staphylococcus aureus
  3. Fungal infections
  4. Complication of abscess formation, congestive heart failure or neurological event
  5. Right-sided endocarditis in IV drug abusers
A
  1. 4-16% mortality
  2. 25-47% mortality
  3. > 50% mortality
  4. Increased mortality if endocarditis is complicated by these events
  5. 10% mortality
30
Q

What causes infective endocarditis?

A

Bacteria entering the blood from outside the body

Human Diseases (24 decks)

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