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Phase 4 - Cardiology > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

What is the definition of endocarditis?

A

Infection of the endocardium with formation of a vegetation resulting in damage to the cusps of valves

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2
Q

What are the risk factors for endocarditits?

A
  • Previously normal valves,
  • Rheumatic valve disease,
  • Prosthetic valves,
  • Congenital heart disease
  • IVDU,
  • Recent piercings,
  • Age > 60,
  • Male sex,
  • Poor dentition
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3
Q

What are the different causes of IE?

A
  • S.aureus (most common cause, especially in IVDU)
  • S.viridans (found in mouth, commonly found in native valve endocarditis)
  • Coagulase negative staph, eg, staph epidermidis (most common in prosthetic valve patients)
  • Streptococcus bovis (associated with colorectal cancer)
  • Non infective: SLE or malignancy
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4
Q

What are culture negative causes of IE?

A

HACEK: haemophilus, actinobacillus, cardiobacterium
Brucella
Bartonella
Coxiella burnetii

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5
Q

What are the symptoms of IE?

A
  • Fever (If fever and new murmur then IE until proven otherwise)
  • Night sweats,
  • Anorexia,
  • Weight loss
  • Myalgia
  • Less common: headaches, arthralgia, abdominal pain, cough, pleuritic pain
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6
Q

What are the signs of IE?

A

Systemic - Febrile, cachectic, clubbing, splenomegaly
Cardiac - Murmur, bradycardia (aortic root abscess tracks down AVN)
Vascular - septic emboli (splenic infarct, stroke), Janeway lesions (painless haemorrhagic lesions)
Immunological phenomena - Splinter haemorrhages, olser’s nodes (painful pulp infarcts), roth spots, glomerulonephritis

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7
Q

What is rheumatic fever?

A

Autoimmune response triggered by group A strep infection. It presents with fever, heart murmur and joint pain.

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8
Q

What is the Modified Dukes Criteria?

A

Used for diagnosis of IE. IE diagnosed if:
- Pathological criteria positive,
- 2 Major criteria,
- 1 major and 3 minor criteria,
- 5 minor criteria
BE FIVE PM

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9
Q

What is the pathological criteria

A

Positive histology or microbiology of pathological material obtained via autopsy or surgery.

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10
Q

What is the Modified dukes criteria major criteria?

A
  • Two positive blood cultures showing typical microorganisms or three blood cultures showing less specific microorganisms or single positive blood culture for coxiella burnetti
  • Positive ECHO (vegitations) or new valvular regurgitiation
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11
Q

What is the minor criteria in the modified dukes criteria?

A
  • Fever > 38,
  • Immunological phenomena (Roth spots, splinter haemorrhages or osler nodes)
  • Vascular phenomena (septic embolis or janeway lesions.
  • ECHO criteria which doesn’t meet major criteria
  • Predisposing features eg, valvular disease, known IVDU.
  • Microbiology evidence which doesn’t meet criteria for major criteria
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12
Q

How can IE be classified?

A

Acute - symptoms for less than 6 weeks.
Subacute - symptoms lasting from 6 weeks to 3 months.
Chronic - Symptoms lasting > 3 months.

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13
Q

What are the investigations for infective endocarditis?

A

Bedside - ECG, urine dip.
Bloods - routine and cultures
Imaging - ECHO, CT CAP to look for evidence of septic emboli

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14
Q

What is the blind management of infective endocarditits?

A

Native valve - amoxicillin +/- gent.
Prosthetic valve - vanc, gent and rifampicin

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15
Q

What is the management for S.aureus IE?

A

Native valve - Flucloxacillin. Second line is vanc and rifampicin. 4 weeks of treatment.
Prosthetic valve - Flucloxacillin, rifampicin and gentamicin. 6 weeks of treatment because of prosthesis

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16
Q

What is the treatment for strep viridans IE?

A

1st line - Benzylpenicillin
2nd line - Vancomycin and gentamicin

17
Q

What is the treatment for HACEK IE?

A

Ceftriaxone

18
Q

PR prolongation can suggest?

A

Aortic root abscess. This is an indication for surgical management

19
Q

What are the indications for surgical management?

A
  • Aortic root abscess,
  • Severe heart failure,
  • Severe sepsis despite antibiotic treatment,
  • Persistent bacteraemia,
  • Persistent emboli
  • Severe valve incompetence,
  • Large vegitations
20
Q

What are the complications of infective endocarditis?

A

Acute valvular insufficiency causing heart failure, neurological complications, embolic complications causing infarcts, infection, glomerulonephritis.

21
Q

Is prophylaxis recomended for IE?

A

No - there was no evidence to suggest it was any good. Unless they are undergoing a GI or GU procedure at a site with suspected infection. NOT for dental proceedures

22
Q

What is the common valve affected in IVDU endocarditis

A

Tricuspid valve

23
Q

What is the treatment for enterococcus species?

A

Amoxicillin +/- Gentamicin

Phase 4 - Cardiology (15 decks)

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