Infective endocarditis Flashcards

1
Q

Definition of infective endocarditis

A
  • Infection of the endocardial surface of the heart
  • Classification based on etiologic agen
  • Pathogenesis: hematogenous spread via bacteremia, and subsequent adherence to (usually) damaged valves
  • Vegetations allow bacterial growth within a protective sheath of fibrin, platelets, and RBCs
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2
Q

Common infectious causes of endocarditis (GP cocci)

A
  • Staph aureus: most common bacterial cause, results in rapid mortality w/o antibio Rx
  • Usually more virulent, can affect normal valves and comes from hospitals or IV drugs
  • Viridians strep: alpha-hemolytic, live in oral cavity
  • Usually infect only damaged valves, more sub-acute Sx
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3
Q

Other infectious causes of endocarditis

A
  • Group D strep (S gallolyticus bovis): associated w/ colon CA, all pts should get colonoscopy
  • Nutritionally deficient strep (abiotrophia, granulicatella)
  • HACEK: GN coccobacilli of normal oral flora
  • H= haemophilus
  • A= actinobacillus
  • C= Cardiobacterium
  • E= Eikenella
  • K= Kingella
  • Culture negative: fungi, rickettsiae, chlamydia
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4
Q

Prosthetic valve IE

A

-Coagulase negative staph (S epidermitidis) most common

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5
Q

Physical findings in IE

A
  • Fever, MSK Sx
  • Changing murmur
  • Peripheral stigmata: splinter hemorrhages (linear under nails), petechiae, osler nodes (tender nodules on digits), janeway lesions (painless macules on palms and soles), roth spots (retinal hemorrhage w/ clear center)
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6
Q

Complications of IE

A
  • CHF
  • Peripheral emboli (brain, kidney)
  • Glomerulonephritis
  • Stroke
  • (!)Mycotic aneurysm (often in brain): due to bacterial invasion, emboli, or immune complex deposition
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7
Q

Criteria for Dx (duke)

A
  • Major: 2 separate positive blood cultures
  • Evidence of endocardial involvement (vegetations) on echo
  • Need 2 major, or 1 major 3 minor or 5 minor
  • Minor: IVDU, any of the peripheral stigmata, etc
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8
Q

Rx of IE

A
  • Bacteristatic antibios will not work, must use bactericidal
  • Indications for surgery: refractory CHF, >1 serious embolic episode, uncontrolled bacteremia >7days, inter cardiac abscess, persistent fever >7 days, fungal endocarditis
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