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Cardio Ped > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

What is infective endocarditis?

A

A very serious microbial endocardial infection with high mortality rates

Requires a high degree of clinical suspicion for early diagnosis.

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2
Q

Who is at risk for infective endocarditis?

A

All children of any age with CHD or Rheumatic conditions

The risk is highest with a pressure gradient, small sized lesions, and less fibrosis.

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3
Q

What two factors are needed for endocarditis to occur?

A
  • Bacteremia
  • Abnormal heart
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4
Q

What is the most common organism causing infective endocarditis?

A

Streptococcus viridans

Accounts for 50% of cases.

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5
Q

What is the second most common organism associated with infective endocarditis?

A

Staphylococcus aureus

Can infect even a normal heart.

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6
Q

What organisms belong to the Coagulase Negative Staphylococci (CONS) group?

A

Coagulase Negative Staph

May follow central line insertion.

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7
Q

Which fungal organism is associated with infective endocarditis in immunosuppressed patients?

A

Candida albicans

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8
Q

What are the HACEK organisms?

A
  • Haemophilus
  • Actinobacillus
  • Cardiobacterium
  • Eikenella
  • Kingella

Associated with infective endocarditis in neonates.

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9
Q

What procedures are risk factors for developing infective endocarditis?

A
  • Dental procedures
  • Tonsillectomy
  • Cardiac surgery (open-heart surgery)
  • Genitourinary surgery
  • Central venous catheter insertion
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10
Q

What congenital heart diseases are associated with infective endocarditis?

A
  • VSD
  • PDA
  • TGA
  • F4

ASD secundum is not included.

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11
Q

What rheumatic valvular diseases are associated with infective endocarditis?

A
  • Mitral regurgitation
  • Aortic regurgitation
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12
Q

What factors increase the risk of infective endocarditis related to previous medical history?

A
  • Prosthetic valve
  • Previous infective endocarditis
  • Surgical shunts
  • Residual defect
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13
Q

What causes damage to the endothelium in the pathophysiology of certain cardiac conditions?

A

Turbulence of blood flow across stenotic or incompetent valves damages the endothelium

This damage can lead to the formation of thrombi.

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14
Q

What forms when circulating bacteria adhere and grow in thrombi?

A

Vegetations

These vegetations can lead to local valve destruction and embolization.

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15
Q

What are the potential embolic phenomena associated with vegetations?

A

Septic embolic phenomena:
* Osteomyelitis
* Meningitis
* Glomerulonephritis

These complications can arise from the embolization of vegetations.

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16
Q

What immunological response occurs in the pathophysiology discussed?

A

Deposition of immune complexes leading to vasculitis and rash

This response can contribute to the clinical manifestations.

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17
Q

In which patients should prolonged fever (> 2 weeks) be suspected as a sign of underlying cardiac issues?

A

Any cardiac patient with unexplained prolonged fever

This symptom is a key indicator in the clinical picture.

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18
Q

What are some specific skin manifestations associated with this condition?

A

Petechial rash, Janeway lesions, Osler’s nodules

Janeway lesions are painless with a necrotic center, while Osler’s nodules are small and painful.

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19
Q

What is a Janeway lesion?

A

Painless hemorrhagic lesion with necrotic center on the palms

Janeway lesions are associated with infective endocarditis.

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20
Q

What is the characteristic of a Roth spot?

A

Retinal hemorrhage with clear center

Roth spots can indicate embolic events affecting the eyes.

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21
Q

What are the symptoms of pulmonary embolism as a result of embolic phenomena?

A

Cough, dyspnea, hemoptysis & chest pain

These symptoms arise from obstruction in the pulmonary circulation.

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22
Q

What can be a consequence of renal embolism?

A

Hematuria

This occurs due to blockage of renal blood flow by emboli.

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23
Q

What are common neurological complications associated with embolic manifestations?

A

Stroke (hemiplegia, convulsions) or Intracranial hemorrhage

These complications arise from cerebral embolization.

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24
Q

What might indicate peripheral vessel involvement in embolic phenomena?

A

Absent peripheral pulsations (Dorsalis pedis or Radial pulse)

This can lead to conditions such as digital gangrene.

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25
Q

True or False: Splinter hemorrhages are linear hemorrhages under the nail bed.

A

True

This is a classic sign associated with embolic events.

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26
Q

Fill in the blank: The separation of vegetations can lead to _______ manifestations.

A

Embolic

This highlights the potential distant effects of local vegetations.

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27
Q

What are the three key symptoms of acute heart failure?

A

Tachycardia, Tachypnea, Tender enlarged liver

These symptoms are referred to as 3T.

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28
Q

What change may occur in the character of an old murmur due to more damage?

A

Change in character of old murmur

This can indicate worsening of the underlying lesion.

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29
Q

What is a seagull murmur indicative of?

A

Rupture of the cusps

This is a new murmur that may appear in certain cardiac conditions.

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30
Q

What are vegetations in the context of cardiac affection?

A

Small inflammatory masses: fibrin, platelets, cells and bacteria

These occur after more than 2 weeks.

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31
Q

What is a osler nodules lesion?

A

Raised, small & painful lesions on the finger tips

These are associated with infective endocarditis.

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32
Q

What is splenomegaly?

A

Enlargement of the spleen

This can occur due to various infections or conditions.

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33
Q

What is the significance of blood cultures in investigations?

A

Very important for diagnosing infections

Cultures should be taken before starting antibiotics and from multiple sites (3-5 cultures).

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34
Q

What type of anemia is typically found in blood pictures related to cardiac affection?

A

Normocytic normochromic anemia

This may occur alongside leukocytosis due to bone marrow inhibition.

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35
Q

What does an increased ESR and positive CRP indicate?

A

Inflammation in the body

These are nonspecific markers of inflammation.

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36
Q

What is the importance of echocardiography in cardiac investigations?

A

Can detect vegetation, old lesions & new lesions

It can be performed trans-thoracic or trans-esophageal, especially if a prosthetic valve is present.

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37
Q

What is a CT brain used for in cardiac investigations?

A

To check for brain embolism

It may show hypodense areas indicative of infarction.

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38
Q

What does a fundus examination detect in cardiac conditions?

A

Retinal hemorrhage

This can be a sign of embolic events.

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39
Q

What findings might a chest radiograph show in cases of pulmonary issues?

A

Bilateral infiltrates, nodules, pleural effusions

These findings can suggest pulmonary embolism or other complications.

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40
Q

What is the purpose of abdominal ultrasound in cardiac affection?

A

To check for renal or splenic affection

This is important if there are signs of organ involvement.

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41
Q

What is assessed with Doppler investigations?

A

Vascular obstruction

This can help diagnose issues related to blood flow.

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42
Q

What are the major criteria for diagnosing infective endocarditis according to the Duke criteria?

A
  1. Positive blood culture:
    • Typical organism including streptococci or staph or HACEK group
    • 2 positive cultures drawn > 12 hours apart for other organisms consistent with lE
  2. Positive Echocardiography: Evidence of endocarditis
    • New vegetation or abscess
    • New valve regurge or variation in the degree of already present regurge

Major criteria are essential for a definitive diagnosis of infective endocarditis.

43
Q

What is considered a positive blood culture in the context of infective endocarditis?

A

Typical organism including streptococci or staph or HACEK group

Atypical organisms can also be considered if there are 2 positive cultures drawn > 12 hours apart.

44
Q

What constitutes a positive echocardiography finding for infective endocarditis?

A

Evidence of endocarditis
* New vegetation or abscess
* New valve regurge or variation in the degree of already present regurge

Echocardiography is crucial for visualizing changes in the heart that indicate endocarditis.

45
Q

What are the minor criteria for diagnosing infective endocarditis?

A
  1. Fever > 38 C
  2. Positive blood culture for atypical organisms (single culture)
  3. Predisposing factors
  4. Vascular Embolic manifestations:
    • Cerebral infarction or hemorrhage
    • Retinal infarction or Conjunctival hemorrhage
    • Splenic infarctions
    • Renal infarction
    • Necrotic skin lesions or gangrene
    • Janeway lesions
  5. Immune complex deposition:
    • Glomerulonephritis
    • Roth spots
    • Splinter hemorrhage
    • Osler nodules
    • Skin Petechiae

Minor criteria help in the assessment when major criteria are not fully met.

46
Q

What does ‘definite infective endocarditis’ mean according to the Duke criteria?

A

Two major criteria, or one major + three minor criteria, or five minor criteria

This classification is critical for confirming the diagnosis.

47
Q

What indicates ‘possible infective endocarditis’ according to the Duke criteria?

A

One major + one minor criteria, or three minor criteria

This classification assists in identifying cases that may require further investigation.

48
Q

True or False: A positive blood culture for atypical organisms is a major criterion for diagnosing infective endocarditis.

A

False

A positive blood culture for atypical organisms is considered a minor criterion.

49
Q

Fill in the blank: A positive echocardiography finding for infective endocarditis includes new _______ or abscess.

A

[vegetation]

Vegetation refers to an abnormal growth on the heart valves indicative of infection.

50
Q

What is a characteristic feature of Osler nodules?

A

They occur on the pulps of fingers or toes

Osler nodules are painful and are indicative of immune complex deposition in infective endocarditis.

51
Q

What is the most important factor for the prevention of infective endocarditis?

A

Good oral hygiene

Good oral hygiene is emphasized as a very important aspect of prevention.

52
Q

What is the recommended dosage of oral amoxicillin for prevention before dental procedures?

A

50 mg/kg as a single large dose one hour before the procedure

This dosage is specifically for dental procedures.

53
Q

What supportive treatment is recommended until heart failure is controlled?

A

Bed rest

Bed rest is recommended until the heart failure is managed and the ESR becomes normal.

54
Q

What dietary restrictions should be considered if a patient has congestive heart failure?

A

Salt and fluid restriction

This is important to manage fluid retention in congestive heart failure.

55
Q

What type of medication is recommended for fever in supportive treatment?

A

Antipyretics

Antipyretics help manage fever associated with infections.

56
Q

What is the initial treatment approach for infective endocarditis until culture results are available?

A

Empirical therapy

Empirical therapy is provided based on clinical suspicion before specific cultures are available.

57
Q

What combination of antibiotics is recommended for suspected methicillin-resistant S. aureus (MRSA)?

A

Vancomycin + Gentamycin

This combination is used for suspected MRSA infections.

58
Q

What is the treatment regimen for Streptococcus viridans or Enterococci infections?

A

Penicillin G or ampicillin or ceftriaxone for 4 weeks and Gentamycin for 2 weeks

This regimen is specified for these bacterial infections.

59
Q

What is the recommended treatment for Staphylococcus aureus infections?

A

Vancomycin for 6 weeks AND Gentamycin for 5 days

This treatment addresses the duration and combination of antibiotics for Staphylococcus aureus.

60
Q

What is the treatment for HACEK organisms?

A

Ceftriaxone alone or ampicillin + gentamycin for 4 weeks

Vancomycin is used if penicillin or ceftriaxone are not tolerated.

61
Q

What is the treatment for fungal infections related to infective endocarditis?

A

Amphotericin B

Amphotericin B is specifically indicated for fungal infections.

62
Q

What surgical interventions may be necessary for infective endocarditis?

A

Removal of vegetation & valve replacement

Surgery is considered in cases of progressive heart failure, prosthetic valve, peri-valvular abscess, large vegetation > 10 mm, or fungal infections.

63
Q

What is the recovery rate for patients with infective endocarditis?

A

80%

This indicates a favorable prognosis for many patients.

64
Q

2 factors needed for endocarditis

A

Bacteremia , abnormal heart

65
Q

Infect endo commonest organism الاشهر

A

Streptococcas viridans
Alpha hemolytic streptococci

66
Q

Infect endo الاخطر

67
Q

Infect endo neonates

68
Q

Ifect endo in immuno compromised

69
Q

Organsims causing infective endocarditis

A

الاشهر strept
الاخطر الstaph
Neonates hacek
Immunocompromised candida
Cons

70
Q

What inc risk in infective nedocarditis

A

Inc pressure gradient
Small size
Less fibrosis

71
Q

What rhematic valvular dx has more risk to infective ndocarditis

72
Q

At tof does vsd has infective endo

A

No bec it is big

73
Q

Which is more prone to infective endo vsd or asd

A

Vsd due to pressure gradient

74
Q

Any cardiac patient with unexplained prolonged fever more than 2 weeks

A

Suspect infective endocarditis

75
Q

Splenic affection in infective endocarditis

A

Splenooooomeglay
Infarction
Ancess

76
Q

Mentio cp of heart incase of infective endocarditis

77
Q

Vegetation components

A

Fibirn pt cells bacr

78
Q

Segull murumr cuasr

A

Rupture of cusps

79
Q

Embolic manifestions of infective endocarditis

80
Q

Hand examination in case of infective endocarditis

81
Q

Routes for infective endo

A

Dental , tonsillectomy من فوق
Gentio urinary من تخت
Cardiac surgry or catherter قلب

82
Q

Lesions causing infective endocarditis

A

Chd
Rhd
Prothestic

83
Q

Why at tof infective endocarditis

A

Due to pulmonory stenosis
Whic is muscular not fibroisi
And vsd not due to kbeeeeer awy

84
Q

Mention inv of infective endometriosis

85
Q

How many blood cultures needeed at infective endocarditis and why

A

3-5 bec if anything happens patient dies

86
Q

Criteria of anemia caused by toxemia

A

Normocytic normochromic with leukocytodis

87
Q

Most imp type of echo ised in infective endocarditis

88
Q

Toxemia manifest

89
Q

Dukes criteria

90
Q

Typical organisms of infective endo

A

Strept
Staph
Hacek

91
Q

How to confrim infective endocarditis using dukes criteria

92
Q

How brain embolism appear in ct

A

Hypodense area

93
Q

Retinal hemorrage with pale center

A

Roth spots

94
Q

Raised small painful nodules under nail tips

A

Osler nodule

95
Q

Paineless hemoorragic lesions with necrotic center on plams

A

Janeway lesion

96
Q

Does surgery is good prognosis for infective endocarditis

A

No carries high mortality rate due to infections

97
Q

Most important prevention for infective endocarditis

A

Oral hygiene

98
Q

Immune complex deposition manifestions

A

GN
Roth spots
Splinter hgh
Osler nodule
Skin petichiae

99
Q

Prevention for oral lr esophageal prosdeure

A

Single amoxicilin before procedure

100
Q

Describe ttt plan for infective endocarditis

101
Q

Pathophydiology of ie

102
Q

Duration of bed rest

A

Untill hf is controlled

103
Q

Only exceprion for abs durstion in infective endocarditis and why

A

Gentamycin for 2 weeks bec ototoxic nephrotoxic

Cardio Ped (10 decks)

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