Infective Endocarditis Flashcards
microbial infection of heart valve, lining of a cardiac chamber or blood vessel, or a congenital anomaly (e.g. septal defect).
Infective endocarditis
Infective endocarditis may affect
Both Prosthetic and native valve
What cause Infective endocarditis
usually a bacterium
Other causes of Infective endocarditis
rickettsia, chlamydia or fungus
What are the bacteria which may cause Infective endocarditis
streptococci or staphylococci
avascular valve tissue and presence of fibrin and platelet aggregates , help to
protect proliferating organisms from host defense mechanisms.
Extracardiac manifestations such as ……. (2)
Due to ………….
vasculitis and skin lesions
emboli or immune complex deposition
Morbidity and mortality in Infective endocarditis are
higher
What is the division of Infective endocarditis based on onset and duration of symptoms before diagnosis
(3)
Acute bacterial endocarditis (ABE)
Subacute bacterial endocarditis(SBE)
Refers to an abrupt onset of symptoms (infective endocarditis)
Acute bacterial endocarditis (ABE)
Insidious, evolves over several weeks or months (infective endocarditis)
Embolic events are common
Acute bacterial endocarditis (ABE)
cardiac or renal failure may develop rapidly
Acute bacterial endocarditis (ABE)
should be suspected when a patient with congenital or valvular heart disease develops:
Persistent fever, Night sweats, Complains of unusual tiredness, Weight loss, and Develops new signs of valve dysfunction or heart failure.
Subacute bacterial endocarditis(SBE)
Congenital heart defects
Risk factor for infective endocarditis
Artificial heart valves
Risk factor for infective endocarditis
History of endocarditis
Risk factor for infective endocarditis
Damaged heart valves
Risk factor for infective endocarditis
History of intravenous (IV) drug abuse
Risk factor for infective endocarditis
Subacute bacterial endocarditis(SBE) should be suspected when a patient with congenital or valvular heart disease develops …………. (5)
Persistent fever
Night sweats
Complains of unusual tiredness
Weight loss
Develops new signs of valve dysfunction or heart failure
malaise
confusion
weakness
Fever
weight loss
Non specific symptoms and signs
Affects normal valves over days to weeks
Acute bacterial endocarditis (ABE)
more likely due to Staphylococcus aureus which has much greater virulence
Acute bacterial endocarditis (ABE)
presents as a severe febrile illness with prominent and changing heart murmurs and petechiae
Acute bacterial endocarditis (ABE)
Clinical stigmata of chronic endocardia are usually absent
Acute bacterial endocarditis (ABE)
Most of the patients of SBE have
murmur
Purpura and petechial hemorrhages on the skin and mucous membrane
Sign of Infective Endocarditis
Splinter hemorrhages under the fingernails or toe nails
Sign of Infective Endocarditis
Osler’s nodes are painful tender swellings at the fingertips
Sign of Infective Endocarditis
due to vasculitis; they are rare.
Janeway Lesions
Sign of Infective Endocarditis
non tender small erythematous or hemorrhagic macule or nodular skin lseions on the palms or soles, only few millimeter in diameter
Janeway Lesions
Digital clubbing
Sign of Infective Endocarditis
late sign
Roth spots
Sign of Infective Endocarditis
Retinal hemorrhages with small, clear centers; immunological event, rare
Roth spots
spleen is frequently palpable
Sign of Infective Endocarditis
liver may be enlarged
Sign of Infective Endocarditis
Microscopic hematuria
Sign of Infective Endocarditis
common
Embolic stroke or peripheral arterial embolism
Sign of Infective Endocarditis
murmur
Sign of Infective Endocarditis
Skin rashes typically consisting of multiple petechiae, often on the legs and conjunctivae , are due to
vasculitis
Dark-red to brown or black , linear lesions on the nail
Subungual (splinter) haemorrhages
Non specific
Tender subcutaneous red spots under the skin of the fingers usually found on the distal pads of the digits
Osler nodes
Rare
Specific
Nontender maculae on the palms and soles(vascular embolic event)
Janeway lesions
Specific
Flame-shaped retinal hemorrhages with a ‘cotton-wool’ centre
result from septic emboli
Similar appearances may occur in patients with anemia or leukemia
Roth’s spots
Seen by fundiscopical examination
(+) blood culture
Major criteria
Endocardial involvement
Major criteria
Typical organism from 2 cultures
Positive blood culture
Persistent positive blood cultures taken > 12 hrs apart
Positive blood culture
3 or more Positive cultures taken over > 1 hr
Positive blood culture
Positive echocardiographic findings of vegetations
Endocardial involvement
New valvular regurgitation
Endocardial involvement
Predisposing valvular or cardiac abnormality
Minor criteria
IV drug misuse
Minor criteria
Pyrexia 38C or more
Minor criteria
Embolic phenomenon
Minor criteria
Vasculitic phenomenon
Minor criteria
Blood cultures suggestive: organism grown but not achieving major criteria
Minor criteria
Suggestive echocardiographic findings
Minor criteria
2 major or 1 major + 3 minor or 5 minor
Definite endocarditis
1 major + 3 minor or 3 minor
Possible endocarditis
Surgical intervention
Management of endocarditis
if there is valvular obstruction,fungal IE, myocardial abscess, unstable infected prosthetic valve
Antibiotics: Penicillin/ gentamicin /vancomycin/amoxicillin
Management of endocarditis
Choice of antibiotics depends on the organism/severity and sensitivity
