Infective Endocarditis Flashcards
Infective endocarditis is infection of the endocardium due to causative _____ colonising abnormal endothelium causing _____
bacteria
vegetations
What are some common bacterial causes of infective endocarditis?
Staph aureus (most common)
Strep viridans
Strep bovis
HACEK organisms (gram negative bacteria)
Staph aureus causing endocarditis is most common in…
IVDUs
T2DM
Surgery
What are the characteristics of s. viridans?
Gram positive bacteria
Alpha haemolytic
Optochin resistant strep.
Associated with poor dental hygiene
Strep bovis is associated with…
Colon cancer
What are risk factors for infective endocarditis?
Elderly male with prosthetic valves
Young IVDU
Young with congenital heart defect
Rheumatic heart disease
Infective endocarditis should always be a differential diagnosis when a patient presents with a fever and a ___ _____
new murmur
Which valve is typically affected in infective endocarditis?
Mitral valve (left side)
(However, in IVDU, tricuspid valve is more common)
Abnormal or damaged endocardium has increased _____ deposition which bacteria adheres to, causing “______”
platelet
vegetations
Vegetations typically occur around valves and can cause ______ so risk of heart failure
regurgitation
What are symptoms of infective endocarditis?
Rather vague:
Fever
Non-specific new valve regurgitation
Sepsis or emboli of unknown origin
What are signs of infective endocarditis?
Osler nodes (finger nodules)
Janeway lesions (painful marks on hands)
Splinter haemorrhages
Roth spots (retinal haemorrhage)
Septic emboli
How is infective endocarditis diagnosed?
ECG: prolonged PR from aortic root abscess
Raised ESR and CRP with neutrophilia
TOE (gold standard)
Blood culture 3 sites over 24 hours
Duke criteria
What do you need to score on the Duke criteria to be diagnosed with infective endocarditis?
2 majors
or
1 major and 2 minors
What are the majors of the Duke criteria for infective endocarditis?
2 or more positive blood cultures
ECHO TOE shows vegetations
What are the minors of the Duke criteria for infective endocarditis?
Immunological signs
IVDU
Septic emboli
1 positive blood culture
Pyrexia (38+ degrees)
What is treatment of infective endocarditis caused by Staph aureus?
Vancomycin and rifampicin for 4-6 weeks
If have prosthetic valve then add gentamycin
What is the treatment for infective endocarditis caused by Strep viridans?
Benzylpenicillin and gentamycin for 4-6 weeks
What is the surgical option for infective endocarditis?
Remove valve if incompetent and replace with prosthetic
What are complications of infective endocarditis?
Heart failure
Aortic root abscess
Septic emboli
Sepsis
