Infective Endocarditis Flashcards
Most common cause of Infective Endocarditis (IE).
Staph aureus
Major cause of early Prosthetic Valve IE.
Staph epidermidis
Major cause of late Prosthetic Valve IE
Viridans strep
Major cause of IE in IVDU
Staph aureus
How does IE presentation differ in IVDU vs. non-IVDU?
In IVDU the Right side of the heart is affected, mainly the tricuspid valve. Also the peripheral manifestations are absent because the lungs are affected first.
Explain the pathogenesis of IE.
- Endocardial Injury Occurs (except in IVDU)
- Fibrin-platelet clot forms (NBTE)
- Microbes enter circulation
- Microbes attach to the clot
4.
What are the 3 necessary components to make a diagnosis of IE?
- Thorough H and P
- Blood Cultures
- Echocardiogram
What is the most sensitive symptom and most reliable sign for IE?
SS: fever
RS: murmur
Name the 5 peripheral signs (stigmata) associated with IE.
- Petechiae (mainly in mouth, conjunctiva, upper extremities)
- Splinter Hemorrhages (under fingernails)
- Osler Nodes (found on finger and toe pads)
- Janeway Lesions (found on palms and soles)
- Roth Spots (retinal hemorrhages)
Describe the pathogenesis of mycotic aneurysms and problematic spots where they occur.
Vegetations occur in the heart due to IE. These break off and block the vasa vasorum.
The vessel walls start to weaken and an aneurysm forms.
These can occur in the aorta or even the cerebral arteries.
What is important to remember b/4 starting antibiotics?
Blood culture for definitive Dx.
What is the standard antibiotic regimen for IE?
4-6 weeks
sometimes valve replacement necessary
What are three indications for emergency valve replacement surgery?
- Acute aortic insufficiency with early closure of the mitral valve
- Rupture of sinus of Valsalva into right-heart chamber
- Rupture of sinus of Valsalva into pericardium
Which 4 groups is there recommended antibiotic prophylaxis for IE?
- Prosthetic Valves
- Previous IE
- Congenital Cardiac Issue
- Cardiac Transplant
