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Year 3 Cardio > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

If any endocarditis risk group member has a fever lasting longer than a week, what must be done?

A

Blood cultures

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2
Q

What percentage of patients with endocarditis have replacement valves?

A

50%

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3
Q

Is endocarditis a subacute or an acute condition?

A

Depends, patients with normal valves follow an acute course whereas patients with abnormal valves tend to follow a subacute course

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4
Q

How does acute endocarditis present most commonly?

A

Heart failure +/- emboli

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5
Q

What is the most common causative bacteria?

A

Staph. Aureus

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6
Q

What are the risk factors for acute course endocarditis? (DROID)

A

Dermatitis, Renal failure, Organ transplant, IV injections, Diabetes Mellitus

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7
Q

Endocarditis on a subacute course (e.g. Somebody with prosthetic valves) occurs in which groups?

A

IV drug users (tricuspid chiefly), prosthetic valves, VSD, PDA, Aortic/Mitral valve disease, Coarctation of the aorta

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8
Q

Endocarditis on prosthetic valves can be classed into what?

A

Early (in surgery carries bad prognosis) or Late (haematogenous)

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9
Q

What is the cause of endocarditis?

A

Bacteramia

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10
Q

Dental procedures often introduce bacteria into the blood so why do we not give routine prophylaxsis?

A

As bacteraemia occurs all the time e.g. When we eat food, it is on when the valves are abnormal, persistent bacteraemia (dermatitis) and in immunocomprimised individuals (DM or HIV)

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11
Q

What is the second most common causative bacteria?

A

Strep. Viridans (35%)

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12
Q

What signs may be visible on the hands?

A

Splinter haemorrhages (5+ highly indicative), janeway lesions, Oslers nodes, clubbing

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13
Q

What are Oslers nodes?

A

Painful pulp infarcts in the fingers and /or toes

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14
Q

What are janeway lesions?

A

Emboli in the skin that appear as erythematous, non-tender, pustular spots on the palms and/or soles

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15
Q

What septic signs may occur?

A

Fatigue, night sweats, malaise, weight loss, anaemia, splenomegaly, clubbing

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16
Q

What cardiac signs may occur?

A

New murmur, changing of an existing murmur, vegetations, aortic root abscess

17
Q

What might vegetations cause?

A

Valve obstruction/destruction and severe regurgitation

18
Q

What might an Aortic valve abscess cause?

A

PR prolongation and eventual complete AV block

19
Q

What renal signs may occur?

A

Microscopic haematuria, glomerulonephritis, acute renal failure

20
Q

What sign may be visible in the eye?

A

Roth spots, boat shaped retinal haemorrhages with a pale centre

21
Q

Where may emboli cause abscesses?

A

Brain, aortic root, heart, kidney spleen, gut

22
Q

What two signs are pathogenomic when found together?

A

Janeway lesions, and Oslers nodes

23
Q

What is the name of the criteria used for diagnosing IE?

A

Duke criteria

24
Q

What are major criteria?

A

Positive blood culture (2 of typical organism or 3 positive blood cultures of atypical taken 12hrs apart)
OR positive echo OR new regurgitation (change not suffficient)

25
Q

What are the minor criteria?

A

Risk group, fever of over 38, vascular or immunological signs, positive blood culture or echo that doesn’t meet major strd,

26
Q

What criteria must be fulfilled to make a diagnosis in the absence of pathogenomic signs?

A

2 major, 1 major and 3 minor, 5 minor

27
Q

When and how to do blood cultures?

A

Different sites at the peak of fever

28
Q

What percentage are diagnosed from the 1st/2nd blood cultures? (1st major criterion)

A

90%

29
Q

If normal echo is unsuccessful in finding vegetation, abscess or prosthetic valve dehiscence (tearing along line of suture) what investigation can be performed?

A

TOE

30
Q

What other investigations should be done?

A

Blood tests, urinalysis, ECG

31
Q

What may blood tests reveal?

A

Normochromic+normocytic anaemia, neutrophilia, high ESR/CRP

32
Q

What should be your management?

A

Refer urgently to cardiologist and microbiologist and treat with antibiotics

33
Q

What is the blind treatment?

A

Amoxicillin +/- gentamicin

34
Q

What antibiotic is used for normal valves with staph (acute course)

A

Flucloxacillin

35
Q

What antibiotics if staph in prosthetic valves?

A

Flucloxacillin+rifampicin+gentamicin

36
Q

Which bacteria carries the poorest mortality?

A

Staph. Aureus (30%)

37
Q

What signs if found are endocarditis until proven otherwise?

A

Fever and new murmur

Year 3 Cardio (4 decks)

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