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Cardiology > Infective endocarditis > Flashcards

Infective endocarditis Flashcards

1
Q

Pathophysiology of IE

A
  • Damaged valves (prosthetic mainly)
  • Fibrin and platelets will deposit
  • on top of that organisms will deposit forming vegetations
  • These vegetations are loosely attached which embolize
  • can lead to strokes, infarctions, abscess
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2
Q

IE

Define IE

A

it’s an endovascular infection of cardiovascular structures. such as cardiac valves, endocardium, large intrathoracic vessels, intrathoracic foreign bodies such as prosthetic valves, pacemakers

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3
Q

IE

IE is more prone on

A

damaged heart valves

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4
Q

IE

The two factors which contributes to the development of IE

A
  • Presence of organisms in blood stream
  • abnormal cardiac endothelium facilitating their adherence and growth
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5
Q

IE

Reasons for bacteremia

A
  • poor dental hygiene
  • IV drug use
  • Soft tissue infection - cellulitis, abscess
  • therapeutic procedures- dental treatment
  • IV cannulae/ venous access
  • cardiac surgery/ pacemakers
  • dialysis via central or femoral line
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6
Q

IE

commonly affected valves

A
  • AV
  • MV
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7
Q

IE

Prosthetic valve endocarditis

A
  • Early- hospital acquired organisms
  • Late- community acquired
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8
Q

IE

Hospital acquired MOs causing PVE

A

Staph aureus. During the first 60 days after valve replacement

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9
Q

IE

Community acquired PVE

A

Strep viridans. occurs after 60 days from the valve replacement

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10
Q

IE

New PVE

A
  • Early- upto 12 months
  • Late- after 12 months
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11
Q

IE

Which PVE is more common nowadays

A

hospital- acquired PVE

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12
Q

IE

common MOs in the mouth

A
  • alpha hemolytic strep viridans
  • dental procedures
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13
Q

IE

MOs in prolonged indwelling vascular catheters

A
  • Staph aureus
  • TPN pts, IVDU,Pts on long standing ABx
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14
Q

IE

Gut and perineum MOs

A
  • Enterococci
  • prolonged hospitalizations, underlying GUT or GIT disease
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15
Q

IE

Bowel malignancy MO

A

Strep bovis (rare)

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16
Q

IE

Native and prosthetic valve endocarditis MOs

A

Staph aureus
Strep viridans
Staph epidermidis

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17
Q

IE

Soft tissue infection MO

A

Staph. (iv drug users, diabetes)

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18
Q

IE

Rare MOs causing IE

A

HACEK
* Haemophilus
* Actinobacillus
* Cardiobacter
* Eikenella
* Kingella

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19
Q

IE

Culture (-) ve

A
  • Coxiella burnetti
  • Chlamydia
  • HACEK
  • Bartonella
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20
Q

IE

Clinical features

A
  • PUO
  • Malaise
  • Clubbing
  • CVS- murmurs, HF
  • Arthralgia, Pyrexia
  • Skin lesions- oslers nodes, splinter hemorrhages, janeway lesions, petechiae
  • Eyes- roth spots, conjunctival splinter hemorrhages
  • Mild splenomegaly
  • Neurological- cerebral emboli, mycotic aneurysm
  • Renal- hematuria, glomerulonephritis
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21
Q

IE

DDs of PUO

A
  • TB
  • Lymphoma
  • HIV
  • SLE
  • Hepatoma
  • RCC
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22
Q

IE

Clubbing due to cardiac issues DDs

A
  • Atrial myxoma
  • Cynaotic HD
  • IE
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23
Q

IE

Osler’s nodes

A

paniful nodes on the pulp of fingers

24
Q

IE

Glomerulonephritis UFR

A
  • Protein +
  • RBC +
25
Q

IE

DDs for a mild splenomegaly

A
  • Typhoid
  • IE
26
Q

IE

L/sided endocarditis sends emboli to

A

systemic circulation ( Brain abscess, splenic abscess)

27
Q

IE

R/ sided endocarditis sends emboli to

A

pulmonary circulation ( multiple lung abscess)

28
Q

IE

Ix

A
  • Blood cultures
  • serological tests
  • FBC
  • BU, SE
  • LFT
  • ESR, CRP
  • Urine
  • ECG
  • CXR
  • Echo
29
Q

IE

Blood cultures

A

3 sets of cultures from 3 different sites

30
Q

IE

FBC findings

A
  • Normochromic normocytic anemia
  • PMN leukocytosis
  • thrombocytopenia/ thrombocytosis
31
Q

IE

LFT

A

ALP elevated

32
Q

IE

ESR, CRP

A

both elevated

33
Q

IE

Urine tests

A

proteinuria, hematuria

34
Q

IE

ECG

A

evidence of MI, conduction defects

35
Q

IE

CXR

A

evidence of HF
R/S endo- multiple pulmonary emboli

36
Q

IE

echo

A

transesoph > transthoracic

37
Q

IE

Complications

A
  • Heart failure due to valvular lesions
  • AV block- brady arrythmias
  • Anemia- microscopic hematuria
38
Q

IE

Heart blocks occur due to

A

aortic root abscess

39
Q

IE

Why is giving PO ABx useless in IE

A

coz valves are relatively avascular. so giving PO ABx won’t penetrate

40
Q

IE

Mx

A

high dose empirical ABx- benzyl penicillin + gentamicin (4-6 weeks)

41
Q

IE

ADRS of gentamicin

A
  • ototoxicity
  • nephrotoxicity
42
Q

IE

Whats done while the pt is on ABx

A

adequate hydration, assess renal function regularly and ask the pt about any tinnitus

43
Q

IE

ABx for suspected staph endo (IVDU, recent Hx of cardiac surgery)

A

Vancomycin
Gentamicin

44
Q

IE

ABx for clinical endo, culture results awaited, no suspicion of staph

A

penicillin
gentamicin

45
Q

IE

ABx for strep endo

A

Penicillin
Gentamicin

46
Q

IE

ABx for enterococcal endo

A

Amoxicillin
Gentamicin

47
Q

IE

ABx for staph endo

A
  • vancomycin
  • Flucloxacillin
  • Benzylpenicillin
  • Gentamicin
48
Q

IE

Indications for surgery

A
  • severe HF due to valvular damage
  • Failure of ABx Rx
  • Large vegetations w evidence of systemic emboli
  • Abscess/ heart block formation in heart
49
Q

IE

Continued fever in a pt w IE

A
  • Incorrect ABx
  • Inadequate dose
  • Complications- abscess
  • Recurrent embolization
  • Large vegetation
  • Unrelated to IE
50
Q

IE

Reason for continued fever in IE with large vegetation

A

ABx can’t penetrate

51
Q

IE

What to look for in continued fever in a pt w IE

A
  • cannula- site infection ( touch cannula site and see if its warm, red, swollen)
  • UTI- catheter
  • Dengue fever
52
Q

IE

for how long can you keep a cannula

A

for 3 days

53
Q

IE

For IE Mx

A

we usually put a central line

54
Q

IE

Prevention

A
  • Good dental hygiene
  • ABx prophylaxis
55
Q

IE

ABx prophylaxis is given

A

indicated cardiac conditions
* Unrepaired cyanotic HD
* Prosthetic valves, valve repair
* past IE
Indicated procedures
* Dental procedures involving gingival tissue
* Respi procedures breaching mucosa
* Procedures on infected skin/ soft tissue
* GIT, GUT procedures on infected system

56
Q

IE

ABx prophylaxis

A
  • Amxoicillin 2g, 1h prior to procedure
  • Clindamycin 600mg or azithromycin 500mg if allergic to penicillin

Cardiology (7 decks)

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