Infective endocarditis

Question 1

Define: Infective Endocarditis

Answer 1

Infection of innermost layer of heart, usually involving valves.

Question 2

History for Infective endocarditis

Answer 2

• Fever (often PUO)
• Non-specifics: weight loss, anorexia, malaise, fatigue…
• Acute Sx: SOB, chest tightness, emboli
• Dental Hx
• PMHx: RF, congenital heart disease, valve replacement, long term lines, bacteraemias, GI issues
• IVDU

Question 3

Examination findings in Infective endocarditis

Answer 3

• Changing murmur
• Clubbing, splinter haemorrhages, Osler’s nodes, Janeway lesions, Roth spots
• Spleen
• Haematuria

Question 4

Investigations for Infective endocarditis

Answer 4

• FBC (low Hb),
• CRP to monitor therapy
• ESR
• 3 blood cultures before Abx
• sereology if cultures -ve
• CXR
• echo

Question 5

Subacute bacterial endocarditis -

Course and agents

Answer 5

Low virulence Strep, often viridans.

Mild-moderate illness over weeks / months.

Question 6

Acute bacterial endocarditis -

Course and agents

Answer 6

Fulminant illness in days.
Staph aureus,
or coagulase -ve Staph in prosthetic valves.

Question 7

Causes of Culture negative Infective endocarditis

Answer 7

Usually post Abx.
HACEK: Haemophilus parainfluenzae, Aggregatibacter/Actinobacillus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae.
Or Aspergillus, Brucella, Coxiella, Chlamydia, Mycoplasma.

Question 8

Emprirical Tx for Infective endocarditis

Answer 8

Prosthetic valve: Vanc, gent, rifampicin;
Native valve acute: Fluclox;
Native valve indolent: Pen + gent.

Question 9

Indications for surgery in Infective endocarditis

Answer 9

• Serious embolism
• Uncontrolled infection
• Significant valve dysfunction
• Lack of response to Abx
• Local pus (eg. perivalvular abscess)
• Congestive heart failure
• Due to prosthetic valve

Question 10

Tx for known organisms in Infective Endocarditis

Answer 10

Strep viridans: Benpen + gent;
MSSA: Fluclox;
MRSA: Vanc + gent;
Enterococci: Ampicillin + gent.