Infective Endocarditis Flashcards

1
Q

what layer of the heart does endocarditis effect

A

endocardium

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2
Q

who is more likely to get endocarditis men or women

A

men

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3
Q

who has a worse prognosis of the disease, men or women

A

women

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4
Q

what are cardiac risk factors that increase the chance of someone having infective endocarditis

A
prosthetic heart valve
rheumatic heart disease 
prior native IE
Aortic stenosis
Ventricular septal defect
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5
Q

what are the classifications of endocarditis

A

acute
subacute
chronic

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6
Q

what are the two clinical manifestations that will present in nearly all cases of infective endocarditis

A

fever

murmur

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7
Q

what clinical findings would give a high index of suspicion that a patient has IE

A
pyrexia of unknown origin 
know IE causative agent
prosthetic material 
new murmur 
new conduction disorder
congenital heart disease
immunocompromised/IVDA
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8
Q

what investigations would you do for IE

A
FBC
U+E
blood cultures
urinalysis
ECG
CXR
Echo
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9
Q

if a patient has IE what might you find in urine

A

blood

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10
Q

if a patient has IE what might the ECG show

A

conduction delay

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11
Q

85% of IE can be put down to what 3 microorganisms

A

streptococci
enterococci
staphylococcus

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12
Q

what Duke criteria’s give a definite diagnosis of IE

A

2major findings or
1 major & 3 minor or
5 minor

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13
Q

what Duke criteria give a possible diagnosis of IE

A

1 major or 3 minor findings

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14
Q

what is the treatment of endocarditis

A

antibiotics

possible surgery

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15
Q

how do you decide what antibiotics to treat a patient that has IE

A

depends on the;
microorganism isolated
sensitivities
resistance

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16
Q

Now compared to a few decades ago, who are the patients that get infective endocarditis

A
those with prosthetic valves
MVP
bicuspid aortic valve 
congenital heart disease
IVDA
immunocompromised
17
Q

what are non-cardiac risk factors for IE

A
IVDA
indwelling medical device
diabetes mellitus
chronic skin infections
GI infections
alcoholic cirrhosis
18
Q

what can cause disruption of valve endothelium which in turn can lead to IE

A
turbulent blood flow
electrodes
catheters
inflammation
rheumatic carditis 
degenerative diseases
19
Q

what symptoms would create high suspicion of IE

A
fever
new murmur
new conduction disorder
pyrexia
prosthetic material
exposure to a IE organism
previous IE
congenital heart disease 
immunocompromised
20
Q

what investigations would you do for IE

A
full bloods
-CRP
-ESR
blood cultures
urinalysis
U+E
CXR
ECG 
Echo
21
Q

what organisms are 85% of IE cases due to

A

stretococci
enterococci
staphylococcus

22
Q

name two types of enterococci

A

faecalis

faecium

23
Q

what is the Duke criteria used for

A

to diagnose IE

24
Q

what are the two requirements in the major criteria

A

identifying organism

providing evidence of infection anywhere within the heart

25
what does the duke minor criteria focus on
clinical findings that could present in endocarditis
26
how long would you continue antibiotic treatment for native valve IE
4 weeks
27
what organisms commonly infect native valves in IE
staphylococci streptococci HACEK species Bartonella spp
28
how long would you continue antibiotic treatment for prosthetic valves
6 weeks
29
what antibiotics would be used for native valve IE
IV gentamicin | and IV amoxycillin (or IV vancomycin)
30
what antibiotic would be used for native valve septis IE
Gentamicin | vancomycin
31
what antibiotics would you use for prosthetic valve IE
gentamicin vancomycin and rifampiein
32
what groups of patients are most likely to get fungi IE
PV IVDA immunocompromised
33
what is the treatment for fungi IE
dual anti-fungals | valve replacement
34
what two fungi can cause IE
candida | aspergillus
35
what is the most seer form of IE
PVE
36
what are the cardiac conditions at highest risk of IE
``` acquired valvular heart disease valve replacement structural congenital heart disease hypertrophic cardiomyopathy previous IE ```
37
taking blood cultures is an essential investigation in IE. How many blood cultures are taken
3 sets at different sites less than 6 hrs between each culture