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Cardiovascular > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

What is the definition of endocarditis?

A

Inflammation of the endocardium which is the inner layer of the heart
Usually involves the valves and characterised by vegetations

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2
Q

What are vegetations made up of?

A

Platelets, fibrin and microorganisms

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3
Q

Describe the process of endocarditis

A

Pathogens gain access to the blood stream - there is adherence to valve surface - persistence of bacteria - proliferation - dissemination

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4
Q

What can vegetations be seen on?

A

Echo - appear as grey masses

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5
Q

How is infective endocarditis variable?

A

Highly variable - acute, fulminant and subacute/ chronic disease

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6
Q

How is infective endocarditis a systemic disease?

A

Embolic strokes, pulmonary embolism, myocardial infarction, infraction of kidney, spleen, mesenteric, skin and has immune response

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7
Q

What are predisposing conditions for infective endocarditis?

A

Prosthetic valves, cardiac devices, intravenous drug users, congenital heart disease, rheumatic valve disease, mitral valve prolapse, immunosuppression and prolonged admission to ITU

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8
Q

What are some signs of endocarditis in other organs?

A

Embolic stroke, roth spots, mitral valve vegetation, pacer lead with vegetation, aortic valve leaflet with perforation, septic pulmonary emboli, splenic infarcts and peripheral finger infarcts

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9
Q

What are the signs and symptoms of infective endocarditis?

A

Fever - chills/rigors, poor appetite and weight loss
Heart murmurs
Less frequent - myalgia, back pain and confusion
Embolic complications

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10
Q

What are some vascular and immunological phenomena?

A

Osler’s Nodes that are red and painful on fingers and toes
Retinal haemorrhages
Splinter haemorrhages

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11
Q

What are some non-specific signs of infection - lab?

A

Elevated C-reactive protein, erythrocyte sedimentation, leucocytosis, anaemia and microscopic haematuria

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12
Q

What is needed for diagnosis of endocarditis?

A

Lab signs of infection and blood cultures (at least 3 sets that are 30 mins apart)
Blood cultures are essential prior to antibiotic therapy is commenced.

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13
Q

What are some common microbiology found in the blood cultures?

A

Staph. aureus, streptococci, enterococci, coagulase negative strep. and HACEK group

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14
Q

What are some microorganisms that cause a negative IE on blood culture?

A

Brucella spp, coxiella burnetti, bartonella spp, and can be non-infective so systemic lupus or marantic endocarditis

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15
Q

What is the imaging used to diagnose endocarditis?

A

Transthoracic echo as soon as IE is suspected
Transoesophageal echo
CT/MRI for detection of embolic events
Positron emission tomography - PET shows areas of inflammation

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16
Q

What is the diagnostic criteria for definite IE?

A

2 major criteria
1 major and 3 minor criteria
5 minor criteria

17
Q

What is the diagnostic criteria for possible and rejected IE?

A

Possible - 1 major and 1 minor
3 minor criteria
Rejected IE - alternative diagnosis

18
Q

What is included in major criteria for IE?

A

Blood culture positive for typical microorganisms
Echo showing valvular vegetation

19
Q

What is included in minor criteria for IE?

A

Predisposing cardiac lesion, IDU, temp., embolic phenomena, immunologic phenomena and positive blood culture not meeting above criteria

20
Q

What decided the patients prognosis?

A

Patient characteristics - older age, comorbidities and diabetes
Infecting microorganism
Presence of cardiac/ non cardiac complications
Echo findings

21
Q

Who is included in endocarditis team?

A

Cardiologist, microbiologist, cardiac surgeon and nurse specialist

22
Q

What is the antibiotic treatment if oral strep. or strep. bovis group?

A

Penicillin G
or amoxicillin or ceftriaxone

23
Q

What is the antibiotic treatment if staph spp. native valves?

A

Flucloxacillin

24
Q

What is the antibiotic therapy if prosthetic valves?

A

Add rifampicin and gentamicin for at least 6 weeks of therapy

25
Q

Describe empirical treatment

A

All valves and waiting on culture
Ampicillin and flucloxacillin and gentamicin
vancomycin and gentamicin

26
Q

What are the indications of cardiac surgery in IE?

A

Heart failure with valvular dysfunction or cardiac complications
Uncontrolled infections - persistent fever and positive blood cultures
Prevention of embolism - if vegetation is particularly large >10mm

27
Q

Describe the natural history of rheumatic heart disease

A

Group A beta-haemolytic strep. infection in 5-15 year olds - acute rheumatic fever - carditis - years later rheumatic heart disease which is progressive valvular disease

28
Q

What is used to diagnose rheumatic heart disease?

A

Clinical features - dyspnoea and symptoms of heart failure
ECG and CXR

29
Q

What valves does rheumatic heart disease usually effect?

A

Typically affects left sided valves, with greater affinity and consequence for the mitral valve
Mitral stenosis most common and possibly regurgitation

30
Q

Describe rheumatic fever on trans-echo?

A

Mitral valve thickened and rigid so movement abnormal
Restriction in opening

31
Q

What are the treatment strategies for rheumatic fever?

A

Primary prophylaxis - to avoid rheumatic fever
Secondary prophylaxis

32
Q

What is used for secondary prophylaxis of rheumatic fever?

A

Penicillin prophylaxis
This prevents progression to chronic
1 year plus treatment in young people

33
Q

What is the treatment for RHD - chronic?

A

Treatment for HF
Diuretics, vasodilators (ACEi/ARB) and treatment for AF - BB/digoxin and anticoagulation (warfarin for mitral stenosis)

34
Q

When is balloon mitral valvuloplasty done in treatment for RHD?

A

Effective if symptomatic mitral stenosis
Suitable for younger patients and pregnancy
Is from femoral vein to RA then to mitral valve

35
Q

When is cardiac surgery used in treatment for RHD?

A

When valvuloplasty is not possible
Severe MR, associated aortic and tricuspid valve disease
Repair may not be feasible
Biosprothetics vs mechanical

Cardiovascular (33 decks)

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