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Cardiology (Fall 2023) > infective endocarditis > Flashcards

infective endocarditis Flashcards

1
Q

what are the three layersof the heart walls

A
  • epicardium (outer, viscwreal pericardium)
  • myocardium (middle, makes up majority of heart)
  • endocardium (inner, lines chambers, valves, vesels
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2
Q

what causes infective endocarditis

A

when bacteria enters the bloodstream and lodges onto a heart valve, especially those with prior damage or turbulent blood flow

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3
Q

what are common oral etiologies of infective endocarditis

A
  • dentla extractions
  • periodontal surgery
  • tooth brushing
  • chewing candy
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4
Q

what are non-oral causes of bacteremia

A
  • IV drug use
  • EGD
  • colonoscopy
  • TURP
  • IV catheters
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5
Q

the localization of infection is determined by what?

A

production of turbulent blood flow

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6
Q

what type of IE is more common

A

Left-sided IE is more common, except among IVDU

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7
Q

what is the main organism causing native valve endocarditits

A

staph aureus

followed by strep

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8
Q

what valve/heart disorders increase risk for infective endocarditis

A
  • rheumatic valvular disease
  • congenital heart disease (PDA, VSD, tetralogy of Fallot)
  • MVP with MR
  • degenerative heart disease, AS d/t bicuspid AV, marfans
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9
Q

what is the most common organism causing prosthetic valve endocarditis

A

staphylococci MC for early
Strep MC for late

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10
Q

what is the MC causative organism in IV drug user endocarditis?

A
  • staph aureus (MC)
  • strep
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11
Q

what valve is MC affected in IV drug user endocarditis

A

tricuspid

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12
Q

what are MC causative organisms for nosocomial/healthcare-assocaited endocarditis

A
  • G+ cocci (MC Staph)
  • enterococci
  • nonenterococcal strep
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13
Q

when is fungal endocarditis MC

A

in IVDU and ICU patients who receive broad-spectrum ABX

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14
Q

what are cardiac risk factors for endocarditis

A
  • previous endocarditis
  • prosthetic valve or pacemaker
  • valvular disease or congenital heart disease
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15
Q

what are non cardiac risk factors for endocarditis

A
  • IVDU
  • IV catheter
  • immunosuppression
  • recent dental or surgical procedure
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16
Q

what is the MCC of death in endocarditis patients

A

heart failure

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17
Q

What are complications for infective endocarditis

A
  • valve regurgitation
  • vegetation obstructing orifices or making emboli
  • conduction system affected by myocardial abscesses
  • intramyocardial abscess or septal rupture
  • supric systemic or pulmonary emboli
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18
Q

what are the MC symptoms of endocarditis

A
  • fever (present in 90%)
  • chills
  • weakness
  • SOB
  • night sweats
  • loss of appetite
  • weight loss
  • MSK pain (back pain)
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19
Q

what are the symptoms of endocarditis related to?

A
  • systemic infection
  • emboli
  • other complications such as CHF
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20
Q

what are the PE findings in endocarditis

A
  • heart murmur (80% except IVDU which is only 33%)
  • CHF (66%)
  • septic emboli
  • petechiae ( does not blanch strep/staph)
  • splinter hemorrhages (strep/staph)
  • janeway lesions (staph)
  • osler nodes (strep)
  • roth spots (strep)
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21
Q

how long does it take endocarditis to manifest?

A

may manifest severely in 2 weeks or may be minimal for 6 months. (wow, thats so helpful)

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22
Q

in a endocarditis patient presenting with a pulmonary emboi, what additional signs and symptoms may you see?

A
  • pleuritic chest pain
  • blood tinged sputum/cough
  • cavitating lesions on CXR
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23
Q

where may systemic emboli present in a patient with endocarditis

A
  • renal arteries
  • cerebral arteries
  • coronary arteries
  • mesenteric arteries
24
Q

what are splinter hemorrages

A

linear red/brown streaks in nail beds caused by vasculitis or emboli (strep/staph)

25
Q

what are janeway lesions

A

erythematous/hemorrhagic macular or nodules, painless patchees on palms or soles caused by emboli (staph)

26
Q

what are osler nodes

A

painful nodes on pads or fingers or toes caused by vasculitis (strep)

27
Q

what are roth spots

A

oval, pale, retinal lesions surrounded by hemorrhage caused by vasculitits (strep)

28
Q

what are neurologic manifestations of endocarditis

A
  • CNS emboli (most serious)
29
Q

what are symptoms of CNS emboli (CVA)

A
  • HA
  • seizures
  • toxic encephelopathy
  • meningoencephalitis
30
Q

What INITIAL diagnostic tests should be ordered in endocarditis suspicion

A
  1. CBC
  2. Blood cultures
31
Q

what would you see on lab tests CBC, UA, ESR, CRP, LDH and lactic acid for endocarditis?

A
  • CBC - anemia
  • elevated ESR, LDH, CRP, lactic acid
  • UA - proteinuria and hematuria
32
Q

what is the process of obtaining a blood culture in endocarditis

A
  • obtain PRIOR to initiation of abx
  • at least 3 sets of cultures from different venipuncture sites with 1st and last samples drawn at least 1 hour apart
33
Q

what is reccomended in ALL cases of suspected IE

A

echocardiography (TTE is sufficient, TEE is more sensitive esp in patients with large body habitus)

34
Q

what is the major diagnostic criteria for IE

A
  • positive blood culture (2+ positive cultures)
  • evidence of endocardial involvement on echo ( intracardiac mass, myocardial abscess, or partial dehiscence of a prosthetic valve)
  • new regurgitant murmur
35
Q

what would suggest evidence of endocardial involvement on echo

A
  • intracardiac mass on a valve or supporting structure
  • myocardial abscess
  • partial dehiscence of a prosthetic valve
36
Q

what are minor criteria for diagnosis of IE

A
37
Q

what is the requirements for definitive IE

A
  • 2 major criteria
  • 1 major, 3 minor
  • 5 minor
38
Q

what is the requirements for possible IE

A
  • 1 major and 1 minor
  • 3 minor
39
Q

what are the 4 aspects of management for patients with IE

A
  • abx therapy
  • management of CHF
  • management of systemic/pulm sequelae
  • surgery
40
Q

what are the Abx treatments for Native valve IE

A
  • Pen G and gentamicin
  • MRSA or pen resistent strep use Vanc
41
Q

what are the abx treatments for IVDU IE

A
  • nafcillin
  • gentamicin
  • vanc
42
Q

what are the abx treatments for prosthetic valve IE

A
  • vanc
  • gentamicin
  • rifampin
43
Q

how long do IE patients stay on abx

A

usually 4-6 weeks

44
Q

what is fungal IE typically treated with

A

amphotericin B (not curative) requires surgery for definitive management

45
Q

what is the surgical procedure done for patients with IE

A

open sternotomy valve replacement, repair or debridement

46
Q

Is delaying surgery to prolong antibiotic therapy ever appropriate if the patient meets surgical criteria? why or why not?

A

sorry this is worded funky!

basically you will rarely see prosthetic valve IE after valve replacement for IE so delaying surgery to prevent prosthetic IE is not necessary.

47
Q

what are indications for surgery

A
48
Q

what dental management should be done in patients with IE

A
  • thorough evaluation for periodontal inflammation, pocketing and caries.
  • treatment/elimination of any oral diseases.
  • full series of intraoral radiographs (when stable)
49
Q

what percent of IE cases are a consequence of invasive procedures that produce a significant bacteremia

A

15-25%

50
Q

what percent of people who develop a valvular infection after a procedure are candidates for antibiotic prophylaxis? what does this mean?

A

50%

this means only 10% of IE cases can be prevented by the administration of pre-procedure antibiotics

51
Q

what endocarditis prophylaxis is just as effective as prophylactic antibiotics

A

maintaining good oral hygiene

52
Q

what is the MC source of spontaneous bacteremia

A

gingivitis

53
Q

who is antibiotic prophylaxis reserved for in endocarditis?

A
  • patients at high risk of IE
  • only for those procedures that have higher likelihood of bacteremia
54
Q

what patients are considered at high risk of IE

A
  • Prosthetic heart valves
  • Prior endocarditis
  • Cyanotic congenital heart disease (unrepaired, repaired, or partially repaired)
  • Cardiac transplantation recipients who developed cardiac valvulopathy
55
Q

what cardiac conditions do NOT require antibiotic prophylaxis

A
  • mitral valve prolapse
  • rheumatic heart disease
  • bicuspid vlave disease
  • calcified aortic stenosis
  • congenital heart conditions (VSD, ASD, hypertrophic cardiomyopathy)
56
Q

what procedures require endocarditis prophylaxis

A
  • dental procedures (gingival tissue, periapical region of teeth, perforation of oral mucosa)
  • respiratory tract procedures (tonsillectomy/adenoidectomy or incision of respiratory mucosa)
  • procedures involving infected skin or msk tissue including I&D of abscess
  • NO LONGER FOR GI OR GU
57
Q

what is the antibiotic regimen for endocarditis prophylaxis

A
  • amoxicillin 30-60 min prior
  • if PCN allergy - clinda, cephalexin, azithromycin or claritromycin
  • if unable to take PO - ampicillin IM/IV or cefazolin, cetriaxone, clinda IM/IV if PCN allergy

Cardiology (Fall 2023) (45 decks)

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