Infective endocarditis

Question 1

What are the clinical features?

(6)

Answer 1

• Hypotension,
• V Muffled “faint = weak” Heart Sounds,
• New Murmur + Fever - think of Infective Endocarditis (IE)
• ‡ Malaise, Rigors.

Question 2

Endocarditis : Definition

Answer 2

• Inner lining of the heart chambers and heart valves
• Typically caused by infection resulting in endothelial lining damage

Question 3

What are the investigations of IE?

Answer 3

1. Blood cultures
2. ECHO

Question 4

What are the risk factors for Infective endocarditis? (5)

Answer 4

1. • A previous episode of endocarditis -> the strongest risk factor.
2. • Rheumatic valve disease.
3. • Prosthetic valves.
4. • Congenital heart defects.
5. • Intravenous drug users (IVDUs: typically causing tricuspid lesion).

Question 5

What is the most common causative organism?

Answer 5

Staph. Aureus is the commonest cause of EI in general.

Question 6

Which causative organism is associated with prosthetic valve surgery?

Answer 6

• Staph. Epidermidis is the commonest cause after prosthetic valve surgery.

Question 7

Which causative organism is associated with poor dental hygeine?

Answer 7

Strept. Viridans are the commonest cause in people with poor dental hygiene or following a dental procedure.

Question 8

What are the elements of the major Duke’s criteria?

Answer 8

1. 2 x Positive blood cultures
   or
   Persistent bacteraemia from 2x blood cultures taken > 12 apart or more than >3 positive BC
2. Evidence of endocardial involvement
   * Positive ECHO
   * New valvular regurgitation

Question 9

What is required in the criteria for diagnosis for Infective Endocarditis?

criteria wise

Answer 9

1. 2 x major criteria
2. 1 major and 3 minor
3. 5 minor criteria

Question 10

What are the vascular signs of IE?

(6)

Answer 10

• Major emboli
• Splenomegaly
• Clubbing
• Splinter haemorrhages
• Janeway lesions
• Petechiae or purpura.

Question 11

What is the discription of Osler’s nodes?

Answer 11

painful, red nodules on the hands or feet that can persist for hours to days.

Question 12

What is description of Janeway lesions?

Answer 12

Non-tender, small, erythematous or hemorrhagic macular or nodular lesions on the soles or palms. (they occur due to septic micro- emboli that deposit the bacteria under the skin).

Question 14

What are the elements of the minor criteria? (5)

Answer 14

.1 Predisposing heart condition or intravenous drug use.
2. Microbiological evidence that does not meet the major criteria.
3. Fever > 38°C.
4. Vascular phenomena - Major emboli, Splenomegaly, Clubbing, Splinter haemorrhages, Janeway lesions, Petechiae or purpura.
5. Immunological phenomena -> Glomerulonephritis, Osler’s nodes, Roth spots.

Question 15

What is the intial emperic management of endocarditis?

Answer 15

Native valve endocarditis -
Amoxicillin +low-dose Gentamicin

Question 16

What is the intial emperic management of endocarditis with penicillin allergy?

Answer 16

• Vancomycin +low-dose Gentamicin

Question 17

What is the antibiotic management of prosthetic valve endocarditis?

Answer 17

• › Vancomycin + low-dose Gentamicin + Rifampicin