Infective Endocarditis

Question 1

What are the 2 major Dukes criteria

Answer 1

1. 2xpostive blood cultures on an typical organism
2. Evidence of vegetation/ abscess/new valve dehiscence/new valve regurgitation on TTE

Question 2

What are the HACEK organisms

Answer 2

Haemophillus
Actinobacillus
Cardiobacterium
Eikella
Kingella

Question 3

What are the minor criteria of Dukes criteria

Answer 3

Fever >38c
Serological evidence of infection or 1x postive blood culture
Embolic phenomenon (Janeway/ splinter/conjuctival haem)
Immunological phenomenon (Roth spots/ glomerulonephritis/ +RhF)
IVDU/ predisposing factor
Echo suggective of IE but not major

Question 4

symptoms of IE

Answer 4

Typically unwell and PUO
May have signs of decompensation
may have chest pain

Question 5

Complications of IE

Answer 5

Tissue destruction
Septic emboli
Arrhythmias
Mycotic aneurysms
Renal failure

Question 6

Investigations of infective endocarditis

Answer 6

3x blood cultures over 1 hour
TTE/ TOE (if thick abscess or strong suspicion but TTE negative)
Bloods (inflam markers/ renal function)
Urine dip
ECG (every 2 days to check PR ?aortic root abscess)

Question 7

Management of IE

Answer 7

Antibiotics are per regional guidance. Guided by microbiology pending culture results

Surgical management

Question 8

Who is surgical management typically reserved for?

Answer 8

Uncontrolled infection
Haemodynamically unstable
Heart block

Question 9

Causative organisms for IE depending of predisposition?

Answer 9

2 Help Emesis (heart valve in 2 weeks = epidermidis)
Diarrhoea and Vomiting (Dentition = viridians (mutis/sanguinis))
Big Bolus (Bowel ca = strep bovis (gallolyticus))
IV Antiemetics (IVDU = Staph aureus)