Infective Endocarditis Flashcards
Endocarditis is the when there is an infection of the inner layer of cardiac tissue that causes it to become inflamed. What is the annual incidence of IE in the UK?
1 - 6–7/100 000
2 - 60–70/100 000
3 - 600–700/100 000
4 - 6000–7000/100 000
1 - 6–7/100 000
- rare can but can carry high mortality
- more common in elderly patients
Endocarditis is the when there is an infection of the inner layer of cardiac tissue that causes it to become inflamed. Is infective endocarditis more common in men or women?
- men
- 3 times more common
Endocarditis is the when there is an infection of the inner layer of cardiac tissue that causes it to become inflamed. However, which of the following patients are at risk of infective endocarditis?
1 - mitral valve stenosis
2 - ventricular septal defect
3 - aortic stenosis
4 - all of the above
4 - all of the above
- infection typically occurs where turbulent blood flow is present
- all have turbulent blood flow due to narrow or valves or defects
- valves are commonly affected as this is generally where turbulent blood flow occurs
Which valves are typically affected in infective endocarditis?
1 - aortic and pulmonary
2 - mitral and aortic
3 - mitral and tricuspid
4 - aortic and tricuspid
2 - mitral and aortic
- can affected any valve, but these are most common
- left side of heart is more commonly affected
Patients with pathology that causes turbulent blood flow in the heart are at an increased risk of infective endocarditis (IE). Even prior to a patient becoming infected what can happen to the endocardium that predisposes the patient to IE?
1 - valves can rupture leading to fibrosis
2 - endocardial damage
3 - ventricular hypertrophy
4 - increased pulmonary pressure
2 - endocardial damage
- collagen and tissue factor are exposed
- platelets/fibrin lead to thrombosis (clot)
- THIS ALL OCCURS EVEN WITHOUT THE PRESENCE OF A MICROBE
Patients with pathology that causes turbulent blood flow in the heart are at an increased risk of infective endocarditis (IE). The turbulent blood flow damages the endocardial lining and a small thrombosis (clot) can form. How would a microbe then infect this exposed/damaged endocardial lining?
1 - abscess
2 - dental procedure
3 - surgery
4 - open wound (cellulitis)
5 - all of the above
5 - all of the above
- anything that increases the patients risk of infection
- always ask questions that relate to these in the history
Patients with pathology that causes turbulent blood flow in the heart are at an increased risk of infective endocarditis (IE). The turbulent blood flow damages the endocardial lining and a small thrombosis (clot) can form, this is called a non-bacterial thrombotic endocarditis (NBTE). If a patient does become infected, bacteraemia can follow. The microbes can then bind to the NBTE, which is called what?
1 - microfilms
2 - biofilms
3 - vegetations
4 - infective NBTE
3 - vegetations
- lots of microbes secrete a matrix which forms a biofilm and behave like a colony
There is an acute and subacute form of infective endocarditis (IE). All of the following are common risk factors for acute IE, EXCEPT which one?
1 - dermatitis (skin breach)
2 - renal failure
3 - aortic/mitral valve disease
4 - immunocompromised
5 - diabetes mellitus
3 - aortic/mitral valve disease
- acute IE is typically associated with normal valves
In patients with acute infective endocarditis, what is the most common organism involved?
1 - Staphylococcus aureus
2 - Viridans streptococci
3 - Streptococcus gallolyticus
4 - HACEK group
1 - Staphylococcus aureus
- used to be Viridans streptococci
In patients with acute infective endocarditis, what is the most destructive organism involved?
1 - Staphylococcus aureus
2 - Viridans streptococci
3 - Streptococcus gallolyticus
4 - HACEK group
1 - Staphylococcus aureus
There is an acute and subacute form of infective endocarditis (IE). Acute IE typically occurs in patients with normal valves. What is the mortality in acute IE?
1 - 0.5-1%
2 - 10-20%
3 - 40-50%
4 - 5-50%
4 - 5-50%
There is an acute and subacute form of infective endocarditis (IE). All of the following are common risk factors for sub-acute IE, EXCEPT which one?
1 - IV drug use
2 - renal failure
3 - aortic/mitral valve disease
4 - ventricular septal defect
5 - patent ductus arteriosum
6 - prosthetic valves
2 - renal failure
- IV drug use = risk of infection
- aortic/mitral valve disease, ventricular septal defect, patent ductus arteriosum and prosthetic valves = all cause turbulent flow
What is the mortality rate of patients with infective endocarditis who do not receive treatment?
1 - 20%
2 - 40%
3 - 60%
4 - 100%
4 - 100%
Which of the following is NOT a common symptom patients with infective endocarditis present with?
1 - fever with night sweats
2 - rigors and malaise (not feeling great)
3 - pulmonary oedema
4 - weight loss
5 - arthralgia
6 - dyspnoea
3 - pulmonary oedema
Which of the following is NOT a common clinical sign in patients with infective endocarditis ?
1 - new/change in murmur
2 - splinter hemorrhages
3 - Osler nodes / Janeway macules
4 - roth spots
5 - Tendon xanthomas or xantholasmata
6 - clubbing
7 - splenomegaly
8 - haematuria
5 - Tendon xanthomas or xantholasmata
- these do not typically occur in a patient with infective endocarditis
- new/change in murmur = turbulent blood flow