Infective Endocarditis

Question 1

What is infective endocarditis

Answer 1

Inflammatory disease of the heart
One of the most serious

Question 2

Characterized by colonization or invasion of the _______or the __________ by ______________ agents

Answer 2

Heart valves
Mural endothelium
Microbiological agents

Question 3

Microbiological agents form ______, __________ with microbiological agents

Answer 3

Bulky, friable vegetations

Question 4

Other sites it can affect include

Answer 4

Aorta, aneurysmal vessels

Question 5

List the 2 clinical subtypes

Answer 5

Acute and subacute

Question 6

Acute;
List the organism involved
Normal/ damaged valve
High or low virulence
Death in how many percent

Answer 6

Staph aureus
Destructive infection on previously normal valve
High virulence
50%

Question 7

SubAcute;
List the organism involved
Normal/ damaged valve
High or low virulence
Death in how many percent

Answer 7

S viridans
Previously damaged valves
Low virulence
Patients recover after appropriate antibiotic therapy

Question 8

Predisposing cardiac conditions to infective endocarditis

Answer 8

Rheumatic heart disease
Congenital heart disease
Myxomatous mitral disease
Degenerative Calcific valvular stenosis

Question 9

Systemic conditions leading to IE

Answer 9

Neutropenia
Immunodeficiency state ( HIV)
Diabetes mellitus
Chronic alcoholism
Indwelling catheters (intracardiac and intravascular)
Drug abusers (injection)

Question 10

Implicated organisms include

Answer 10

Bacteria
Strep viridans, S faecalis
Staph
S pneumoniae
Gram neg organisms: E. coli
Viruses
Fungi

Question 11

Morphology

Answer 11

Friable , bulky vegetations on the heart valve
Ring abscess of the valves
Organization and fibrosis

Question 12

Clinical course

Answer 12

Usually non specific
Fever
Malaise
Weight loss
Petechial haemorrhage
Subungal haemorrhage (injury of the nail bed)
Roth’s spot

Question 13

Roth’s spot

Answer 13

Embolism of the central area of the retina may cause canoe shaped haemorrhagic spot with pale centre

Question 14

Complications of infective endocarditis
Cardiac

Answer 14

Valvular insufficiency with cardiac failure
Myocardial ring abscess with perforations
Suppurative pericarditis
Dehiscence of artificial valves

Question 15

Extracardiac complications

Answer 15

Emboli with septic infarcts of
Brain
Spleen
Kidneys
Lungs (pneumonia abscess)

Question 16

Renal complications

Answer 16

Embolic infarcts
Focal GNitis leading to nephrotic syndrome and renal failure
Diffuse Gnitis due to Ag -Ab complex formation
Multiple renal abscess with staphylococci

Question 17

Diagnosis :
Clinical and laboratory

Answer 17

Clinical: take a good history
Observe clinical features
Do a cardiac examination

Laboratory
Blood culture: this may harvest any of the causative organisms

Question 18

Non bacterial thrombotic endocarditis is also called

Answer 18

Marantic endocarditis

Question 19

NBTE
Vegetations are seen in _____

Answer 19

Patients with debilitating illness

Question 20

NBTE is associated with

Answer 20

Mucinous adenocarcinoma
Mucin has a pro coagulant effect
Also associated with promyelocytic leukemia
Hyperestrogenic state

Question 21

Morphology of NBTE

Answer 21

Deposition of small sterile fibrin masses in valve leaflets that are normal and vegetations do not contain microorganisms

Question 22

NBTE mostly affects what valves

Answer 22

Aortic and mitral valves
May cause embolism

Question 23

Liebman- sacks disease

Answer 23

Mitral and tricuspid valvulitis occurring in SLE

Question 24

Morphology of LSD

Answer 24

Lesions are small
Sterile and granular
Located in under surface of AV valves
Consists of eosinophilia material that contains haematoxylin bodies
Intense valvulitis with fibrinoid necrosis
Vegetations rarely embolises but becomes fibrosed