Infective Endocarditis Flashcards
what is infective endocarditis?
infection of the heart endothelium - often affects the heart valves
Risk factors for infective endocarditis?
Intravenous drug use
Structural heart pathology
Chronic kidney disease (particularly on dialysis)
Immunocompromised (e.g., cancer, HIV or immunosuppressive medications)
History of infective endocarditis
What kind of structural hearth pathology increases risk of infective endocarditis?
Valvular heart disease
Congenital heart disease
Hypertrophic cardiomyopathy
Prosthetic heart valves
Implantable cardiac devices (e.g., pacemakers)
Most common cause pathogen for infective endocarditis?
Staphylococcus aureus
Other causes of infective endocarditis?
Streptococcus (notably the viridans group of streptococci)
Enterococcus (e.g., Enterococcus faecalis)
Rarer causes include Pseudomonas, HACEK organisms and fungi
Presentation for infective endocarditis?
non specific
Fever
Fatigue
Night sweats
Muscle aches
Anorexia (loss of appetite)
What are key examination findings for infective endocarditis?
New or “changing” heart murmur
Splinter haemorrhages
Petechiae (small non-blanching red/brown spots) on the trunk, limbs, oral mucosa or conjunctiva
Janeway lesions (painless red flat macules on the palms of the hands and soles of the feet)
Osler’s nodes (tender red/purple nodules on the pads of the fingers and toes)
Roth spots (haemorrhages on the retina seen during fundoscopy)
Splenomegaly (in longstanding disease)
Finger clubbing (in longstanding disease)
Investigations for infective endocarditis?
3 blood cultures before abx
ECHO and TOE
What is the modified Duke criteria?
used to diagnose IE
One major plus three minor criteria
Five minor criteria
what are the Major criteria in Duke criteria?
Persistently positive blood cultures (typical bacteria on multiple cultures)
Specific imaging findings (e.g., a vegetation seen on the echocardiogram)
what are the minor criteria in Duke criteria?
Predisposition (e.g., IV drug use or heart valve pathology)
Fever above 38°C
Vascular phenomena (e.g., splenic infarction, intracranial haemorrhage and Janeway lesions)
Immunological phenomena (e.g., Osler’s nodes, Roth spots and glomerulonephritis)
Microbiological phenomena (e.g., positive cultures not qualifying as a major criterion)
Management for infective endocarditis?
IV broad abx (amoxicillin)
4 weeks for with native heart valves
6 weeks for patients with prosthetic heart valves
surgery:
Heart failure relating to valve pathology
Large vegetations or abscesses
Infections not responding to antibiotics
Key complications of infective endocarditis?
high mortality
Heart valve damage, causing regurgitation
Heart failure
Infective and non-infective emboli (causing abscesses, strokes and splenic infarction)
Glomerulonephritis, causing renal impairment
Prophylaxis for infective endocarditis?
abx not routinely given for dental work (case by case basis)
look after oral health to reduce risk of infective endocarditis
