Infective Endocarditis

Question 1

Continuous bacteremia with what pathogens almost always indicates infective endocarditis

Answer 1

Strep viridans, Staphylococci and enterococci

Question 2

What happens if you do not treat endocarditis

Answer 2

you die

Question 3

pathogenesis of endocarditis

Answer 3

abnormality or injury to the endocardium usually in a heart valve causes platelet and thrombin aggregation called NBTE that bacteria can attach to and form a bacteria platelet mix called vegitation

Question 4

Why are bacteria in vegitaiton protected from hot defense

Answer 4

endocardium is avascular so it depends on immune cells in the blood stream which can not reach bacteria through the platelet and thrombin deposits

Question 5

What complications will continued endocarditis eventually lead to

Answer 5

valvular dysfunction, abscess, peripheral embolization, and heart failure

Question 6

Endocarditis dissemination

Answer 6

frequent because bacteria is continually shed into the blood, this can lead to circulating immune complexes/CIC from immune response in blood

Question 7

What was the most common cause of endocarditis before antibiotics

Answer 7

rheumatic fever from group A Streptococci

Question 8

What was the most common cause of endocarditis before antibiotics

Answer 8

rheumatic fever from group A Streptococci

Question 9

What is the most common cause of endocarditis since the advent of antibiotics

Answer 9

mitral valve prolapse

Question 10

What two things are required for infective endocarditis

Answer 10

valvular damage and bacteremia

Question 11

What can lead to transient bacteremia

Answer 11

gingival trauma when brushing teeth, chewing hard candy and mucosal trauma from straining to take a poo, the body can usually clear these bacteremias before they reach the heart

Question 12

Why do you take prophylactic antibiotics before dental procedures if you have valvular abnormalities

Answer 12

oral Streptococci and Staphlococci have surface characteristics that facilitate attachment to NBTE

Question 13

Microbes that can lead to endocarditis in the early post operative period of prosthetic valve replacement

Answer 13

Coagulase negative Staphylococci from intravenous catheters, gram negatives from urinary catheters, and fungi from the overuse of antibiotics, 2 months post op the new valve is endothelialized and potential organisms are more like that of native valves

Question 14

pthogenesis of endocarditis in intravenous drug users

Answer 14

Usually the tricuspid not the mitral valve is damaged by foreign material cut with the drug, Staph aureus and other skin flora are more predominant pathogens from constant skin trauma, since lesions are on the right side the symptoms are pulmonary

Question 15

Main symptoms of infective endocarditis

Answer 15

Almost always fever and murmur (follow daily to track further valve damage), prolonged malaise and fatigue, petechiae, and splenomegaly

Question 16

Bacteria that cause subacute bacterial endocarditis

Answer 16

Streptococci

Question 17

Bacteria that usually cause Acute Bacterial Endocarditis

Answer 17

Staphylococci

Question 18

What treatment history should prompt suspicion for endocarditis

Answer 18

Repeated short courses of oral antibiotics that alleviated symptoms but symptoms returned when course ended

Question 19

Splinter hemorrhages

Answer 19

Sometimes a symptom of endocarditis but can also indicate trauma, sublingual linear dark red streaks

Question 20

Roth spots

Answer 20

oval retinal hemorrhages with pale center that can be a symptom of endocarditis, CT disorder, or severe anemia

Question 21

Osler nodes

Answer 21

small painful nodules in finger and toe pads from CIC deposition

Question 22

Peripheral emboli

Answer 22

motion of valves makes dislogement of vegetation frequent, leads to shedding and distal infection esp in joints, kidney, spleen, arteries, bones and lung

Question 23

Janeway lesions

Answer 23

small hemorrages that are nodular to flat in palms and soles that might be organism deposition

Question 24

Myocardial abscess

Answer 24

local extension/invasion into conduction system that manifests as myocardial abscess

Question 25

Diagnosis of infective endocarditis

Answer 25

Serial blood cultures taken before antibiotics that are always positive regardless of time they are taken, microhematuria and protenuria can help diagnose and transthoracic ECG can show vegetation

Question 26

Requirements of antibiotic therapy for endocaditis

Answer 26

Bactericidal antibiotics must be given in IV, reach high blood concentrations, and penetrate the vegitation

Question 27

Treatment for Strep endocarditis

Answer 27

4 weeks of penecillin alone or with aminoglycoside unless allergies or contraindication then vancomycin or a cephalosporin

Question 28

Treatment for Enterococcus endocarditis

Answer 28

Very resistant bacteria, Ampicillin combined with aminoglycoside for 6 weeks

Question 29

Treatment for Staph endocarditis

Answer 29

beta lactamase stable penicillin if susceptible with aminoglycosides for the first 2-5 days for S. aureus

Question 30

Treatment for IV drug abuser endocarditis

Answer 30

2 week antibiotic course

Question 31

Treatment for prosthetic valve nedocarditis

Answer 31

multi-drug regimen for 6 weeks, careful evaluation and early valve replacement surgery when needed

Question 32

5 indications for valve replacement surgery

Answer 32

1.Persistently positive cultures after antibiotics 2.intractable heart failure, watch for deterioration in hemodynamic status 3.intracardiac abscess which manifests with increasing conduction block 4.recurrent emboli esp with antibiotics 5. fungal or drug resistant bacterial endocarditis