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anatomical pathology > Infective endocarditis > Flashcards

Infective endocarditis Flashcards

1
Q

Clinical features most common for subacute endocarditis (4)

A
  • Slower onset
  • Fever, malaise, fatigue, loss of weight
  • Clubbing — symptom of chronic suppurative condition
  • Murmurs
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2
Q

What are the most common sites of valve damage in subacute endocarditis?

A

Mitral and aortic valve commonest

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3
Q

Intracardiac factors that can show risk for endocarditis are? (6)

A
  • Chronic RHD
  • Congenital cardiac abnormalities
  • MV prolapse
  • Degenerative calcific stenosis
  • Bicuspid AV
  • Prosthetic valves + indwelling catheters
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4
Q

What are some of the host factor’s contributory conditions for endocarditis? (4)

A
  • Immunodeficiency
  • Neutropaenias (abnormally low levels of neutrophils)
  • Malignancy
  • Diabetes mellitus
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5
Q

What are the major clinical findings for endocarditis? (3) duke

A
  • Positive blood culture indicating characteristic organism or persistence of unusual org.
  • ECG — valve- or implant-related mass or abscess, partial separation of artificial valve
  • New valvular regurgitation
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6
Q

Staph aureus is most likely to cause which type of endocarditis?

A

Acute endocarditis

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7
Q

Clinical features most common for acute endocarditis? (3)

A
  • Rapid onset, fever, rigors, malaise
  • Chest pain, dyspnoea, rapid fatigue
  • Sudden death
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8
Q

Describe acute endocarditis (virulence, vegetation)

A
  • Highly virulent i.e.staph aureus (ATTACK NORMAL VALVES)
  • Vegetations are at the line of valve closure
  • Easily dislodgable vegetation
  • Fulminating (pt can die withing 6 weeks if not treated)
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9
Q

Origin of infection in endocarditis (7)

A
  • Trivial injuries
  • Poor dental hygiene
  • Recent surgery or non-surgical invasive procedure
  • IV drug use
  • Localised suppurative inflammation
  • Systemic sepsis
  • Long-term haemodialysis
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10
Q

Using the duke criteria, what is the clinical criteria for endocarditis?

A
  • 2 major findings
  • 1 major + 3 minor findings
  • 5 minor findings
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11
Q

Regurgitation with regards to valvular disease means?

A

Failure to close sufficiently, allows reversed flow = volume overload

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12
Q

Which population is most at risk for acute endocarditis (3)

A
  • IV drug users
  • Pt with intracardiac catheters ( risk for right sided endocarditis)
  • Older pts
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13
Q

Complications of infective Endocarditis (6)

A
  • Systemic embolisation
  • Septicaemia
  • Brain abscesses, splenic or renal infection — septic infarcts - Right sige — pulmonary septic infarcts
  • Ring abscess — erodes into underlying myocardium
  • Valve cord/rupture
  • Immune complex formation — leads to glomerulonephritis
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14
Q

Stenosis with regards to valvular disease means?

A

Failure to open sufficiently, impedes forward flow = pressure overload

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15
Q

Once diagnosis of infective endocarditis is considered what are the 2 essential investigations? (3)

A
  • Echocardiogrpahy (transthoracic or transoesophageal)
  • Blood cultures — 3 in 24 hour period (multiple daily)
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16
Q

Sources of low virulence organisms that could cause subacute endocarditis? (5)

A
  • Teeth
  • Gums (Streptococcus viridans variety)
  • Urinary tract
  • Skin
  • Lungs
17
Q

What are some minor clinical findings for endocarditis? (6)

A
  • Predisposing heart lesion or IV drug use
  • Fever
  • Vascular lesions — petechiae, splinter haemorrhages
    Osler’s nodes, Roth spots    , septic infarcts, Janeway lesions
  • Immunologic phenomena — glomerulonephritis, splinter haemorrhages
    Osler’s nodes, Roth spots
  • Single culture showing uncharacteristic organism
  • ECG findings consistent with but not diagnostic of endocarditis — incl. new valvular regurgitation and pericarditis
18
Q

Most common charactersistics for hosts of subacute endocarditis (3)

A
  • Immunodeficient patients
  • Abnormal valves -> prior damage by non-infective
    endocarditis (RHD in 50%), floppy valves, prosthetic
    valves
  • Congenitally abnormal hearts ® VSD, PDA in 20%
19
Q

Describe subacute endocarditis (4)

A
  • Involves organisms of low virulence organisms i.e. strep viridans
  • Can affect people or any age group
  • Usually occurs on incompetent MV
  • Lasts 6-12 weeks
20
Q

List the anatomical findings associated with infective endocarditis

A
  • Friable, bulky vegetations
  • Fibrin, platelets and organisms
  • Destruction of cardiac tissue
  • Single or multiple valves affected –
  • Mitral and aortic commonest
  • Fungal IE results in larger vegetations
21
Q

Which classification of endocarditis as opposed to the other?

A

Acute endocarditis is highly destructive with high mortality

anatomical pathology (4 decks)

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