infective endocarditis Flashcards
who is at risk of IE?
-valve replacements
-congenital heart disease (except atrial septum defect)
-valvular heart disease
-hypertrophic cardiopathy
-previous IE
how would someone with IE present?
malaise
night sweats
rigors
weight loss
shortness of breath
pyrexia (fever)
heart murmur
embolic disease
what are the symptoms of IE?
malaise
fever
heart murmur
anorexia
night sweats
positive blood culture
unexplained embolism
how is IE investigated?
-blood cultures
-echocardiograph (may see vegetation)
-c reactive protein inflammatory marker
how is IE treated?
IV antibiotics- 4 weeks
amoxicillin
flucoxicillin
how should IE patients be followed up?
-repeat bloods
-high risk recurrence
-ohi - to reduce extractions/bacteraemia
-educate on symptoms
what are the prophylaxis antibiotics used for adults?
amoxycillin- 3g
allergy-clindamycin 600mg
children prophylaxis ?
amoxycillin 600mg 50mg/kg
allergy clindamycin 20mg/kg max 600mg
what is the advice for prophylaxis published in NICE?
ab prophylaxis is not to be used routinely
what factors should you consider for high risk patients?
-immune status
-medical status
-infection
-invasiveness of procedure
-increase in cases since 2008
how does bacterial vegetation occur on heart valves?
-lesion on valve
-platelets attracted- makes surface sticky
-bacteria attach from blood stream
-vegetation as microbes proliferate
-infection develops
-potential for embolic disease
what valves may be affected?
LHS- mitric and aorta
RHS-IVDU
valve can rupture
what causes remote embolic effects?
bits flake off vegetation and travel round the body-may cause stroke, meningitis
where are remote embolic effects often seen?
extremities (limbs) or mucous membranes
where would you see janeway lesions?
palms
