Infective endocarditis

Question 1

Pathophysiology

Answer 1

Inflammation of endocardium usually causing valvular damage

Question 2

Symptoms

Answer 2

Fever
Dyspnoea
Fatigue
New heart murmur

Question 3

Causes

Answer 3

Strep Viridans - Mouth
Staph Aureus - Skin (IV drug use)
Staph Epidermidis - Skin (IV Line, Surgery)(Prosthetic)
Staph Bovis - GI tract (IBD, Gi Ca)
Candida
Aspergillus

Question 4

Risk factors

Answer 4

Valve prolapse
Congenital valve defects
IV Drug use
Poor dental hygeine
Recent surgery
Rheumatic fever damage
Prosthetic heart valve

Question 5

Examination findings inspection

Answer 5

Janeway lesions
Oslers nodes
Splinter haemhorrages
Needle marks
Surgical scars
Poor dental hygeine
Bounding/ collapsing pulse, Abnormal pulse pressure, Head bopping, quinkes sign

Question 6

Examination findings Auscultation

Answer 6

New murmur
Pan systolic blowing murmur loudest in 5th IC MCL, radiating to axilla, Decreased S1 sound (Mitral)
Early diastolic blowing murmur loudest in pulmonary region leaning forward in full exhalation (aortic)

Question 7

Investigations

Answer 7

Routine bloods
Urinanalysis
CXR
ECG
Echo
3x Culture (before abx if possible)

Question 8

Treatment

Answer 8

A-E
Sepsis screen
IV Antibiotic therapy
Surgery

Question 9

Antibiotic Choices

Answer 9

Strep Viridans - Benzylpenicillin and low dose Gentamicin
Staph Aureus/Epidermidids - Flucloxacillin and low does Gentamicin

Question 10

Surgery Indications

Answer 10

Valve dehisence
Uncontrolled infection
Fungal infection
Moderate/severe cardiac failure
Valve obstruction
Paravalve Infection