infective endocarditis

Question 1

what is infective endocarditis

Answer 1

Infection of the heart valves and/or other endocardial lines structures within the heart

e.g. septal defects, pacemaker leads, surgical patches etc

Question 2

what did endocarditis used to be a disease of ie who did it used to affect

Answer 2

Used to be a disease of the young affected by rheumatic heart disease

Question 3

who does endocarditis affect now (5)

Answer 3

• The elderly (in an ageing population)
• Young IV drug abusers
• Young congenital heart disease
• Anyone with prosthetic heart valves or pacemakers
• Poor dental hygiene

Question 4

is endocarditis more common in males or females

Answer 4

males

Question 5

most common cause of infective endocarditis

Answer 5

S. Aureus

(IVDU, Diabetes and surgery)

Question 6

other causes of infective endocarditis

Answer 6

Pseudomonas aeruginosa

Streptococcus viridans (DENTAL PROBLEMS) – gram positive, alpha haemolytic and optochin resistant

Question 7

general symptoms of infective endocarditis

Answer 7

Headache
Fever
Malaise
Confusion
Night sweats

Question 8

other symptoms of infective endocarditis

Answer 8

Fever plus

• Prosthetic material in heart
• Risk factor for IE e.g. IVDU
• Newly developed ventricular arrhythmias or conduction disturbances

Question 9

5 signs of infective endocarditis

Answer 9

1. Splinter haemorrhages on nail beds of fingers
2. Roth spots – retinal haemorrhages with white or clear centres on fundoscopy
3. Janeway lesions – haemorrhages and nodules in fingers
4. Osler nodes – tender nodules in fingers
5. Clubbing

Question 10

FROM JANE mnemonic for endocarditis

Answer 10

Fever
Roth’s spots – retinal haemorrhages
Osler’s nodes – painful spots on hand
Murmur - arrhythmia
Janeway lesion – painless spots
Anaemia
Nail-bed splinter haemorrhages (splinter)
Emboli – MI, stroke, PVD

Question 11

what criteria used for diagnosis

Answer 11

modified dukes criteria

Question 12

what are the 2 major criteria for diagnosis

Answer 12

Bugs grown from blood cultures

Evidence of endocarditis on echo, or new valve leak

Question 13

what are the 5 minor criteria for diagnosis

Answer 13

Predisposing factors
Fever
Vascular phenomena
Immune phenomena
Equivocal blood cultures

Question 14

what do you need for a definite infective endocarditis diagnosis

Answer 14

2 majors
1 major + 3 minors
5 minors

Question 15

what do you need for a possible infective endocarditis diagnossi

Answer 15

1 major
1 major + 3 minors
5 minors

Question 16

5 investigations to carry out

Answer 16

1. Transoesophageal Echo (TOE) - DIAGNOSTIC
2. Transthoracic echo (TTE)
3. ECG
4. CXR – cardiomegaly
5. Blood cultures

Question 17

describe transoesophageal echo

Answer 17

Generally safe but risk of perforation or aspiration

Easiest if ventilated (but never ventilate just for TOE)

Question 18

describe transthoracic echo

Answer 18

Safe
Non-invasive
No discomfort
Often poor images so lower sensitivity

Question 19

3 treatment options

Answer 19

1. antimicrobials
2. treat complications
3. surgery

Question 20

how to give antimicrobials

Answer 20

IV for around 6 weeks, choice of agent(s) based on culture sensitivities

Question 21

what to use if it is not staphylococcus

Answer 21

use penicillin – benzylpenicillin and gentamycin

Question 22

what to use if it is staphyloccus

Answer 22

use vancomycin and rifampicin

Question 23

what complications can you treat

Answer 23

arrhythmia, HF, heart block, embolisation, stroke rehab, abscess drainage etc.