Infective endocarditis

Question 1

what is infective endocarditis?

Answer 1

Infection of heart valve/s or other endocardial lined structures within the heart (such as septal defects, pacemaker leads, surgical patches, etc).

A really bad infection, plus showers of infectious material around your bloodstream, and/or damaging the heart valves to cause heart failure

Question 2

what is the treatment of infective endocarditis?

Answer 2

-Mainstay is antibiotics/antimicrobials

-May require cardiac surgery to remove the infectious material and/or repair the damage

-Treatment of other complications (emboli, arrythmia, heart failure, etc)

Question 3

what are the different types of infective endocarditis?

Answer 3

-Each type can have different presentations, pathogens and outcomes
-Left sided native IE (mitral or aortic)
-Left sided prosthetic IE
-Right sided IE (rarely prosthetic as rare to have PV or TV replaced)
-Device related IE (pacemakers, defibrillators, with or without valve IE
-Prosthetic; can be Early (within year) or Late (after a year) post op

Question 4

how can you catch infective endocarditis?

Answer 4

Have an abnormal valve; regurgitant or prosthetic valves are most likely to get infected.
Introduce infectious material into the blood stream or directly onto the heart during surgery
Have had IE previously

Question 5

what is the clinical presentation of infective endocarditis?

Answer 5

-Depends on site, organism, etc
-Signs of systemic infection (fever, sweats, etc)
-Embolisation; stroke, pulmonary embolus, bone infections, kidney dysfunction, myocardial infarction
-Valve dysfunction; heart failure, arrythmia

Question 6

describe modified dukes criteria for diagnosis

Answer 6

2 Major Criteria
-Pathogen grown from blood cultures
-evidence of endocarditis on echo, or new valve leak
5 Minor Criteria
-Predisposing factors
-Fever
-Vascular phenomena
-Immune phenomena
-Equivocal blood cultures

Question 7

who is infective endocarditis the most common in?

Answer 7

the elderly, young IV drug abusers and anyone with prosthetic valves.

Question 8

what are the physical characteristics of IE?

Answer 8

-Petechiae (skin lesions)
-Splinter haemorrhages (bruised nails)
-Osler’s nodes (small, tender, purple nodules on the pulp of the digits)
-Janeway lesions (non-tender lesions on the fingers, palm or sole)
-Roth spots on fundoscopy

Question 9

What is the treatment for infective endocarditis?

Answer 9

-Antimicrobials; IV for 6 weeks
-Treat complications; arrhythmia, HF, heart block, embolisation, stroke rehab
-Surgery

Question 10

what are the indications for surgery?

Answer 10

-Infection cannot be cured with antibiotics
-Complications (severe valve damage)
-To remove infected devices
-To replace valve after infection cured
-To remove large vegetations before they embolise

Question 11

what is needed for diagnosis?

Answer 11

-Raised CRP
-ECG
-TTE (transthoracic echocardiography) – crucial to detect a vegetation
-TOE (transoesophageal echo) – improved the rate of detection of vegetations
——a negative TTE/TOE does not eliminate IE possibility
-Many blood tests require long incubation periods for the organisms to grow so provide very slow results.

Question 12

what are the causes for infective endocarditis?

Answer 12

-Have an abnormal valve; regurgitant or prosthetic valves are most likely to get infected

-Introduce infectious material into the blood stream or directly onto the heart during surgery

-Have had IE previously

Question 13

what does Peripheral stigmata mean?

Answer 13

physical characteristic of disease