Infective Endocarditis Flashcards
what layer of the heart does endocarditis effect
endocardium
who is more likely to get endocarditis men or women
men
who has a worse prognosis of the disease, men or women
women
what are cardiac risk factors that increase the chance of someone having infective endocarditis
prosthetic heart valve rheumatic heart disease prior native IE Aortic stenosis Ventricular septal defect
what are the classifications of endocarditis
acute
subacute
chronic
what are the two clinical manifestations that will present in nearly all cases of infective endocarditis
fever
murmur
what clinical findings would give a high index of suspicion that a patient has IE
pyrexia of unknown origin know IE causative agent prosthetic material new murmur new conduction disorder congenital heart disease immunocompromised/IVDA
what investigations would you do for IE
FBC U+E blood cultures urinalysis ECG CXR Echo
if a patient has IE what might you find in urine
blood
if a patient has IE what might the ECG show
conduction delay
85% of IE can be put down to what 3 microorganisms
streptococci
enterococci
staphylococcus
what Duke criteria’s give a definite diagnosis of IE
2major findings or
1 major & 3 minor or
5 minor
what Duke criteria give a possible diagnosis of IE
1 major or 3 minor findings
what is the treatment of endocarditis
antibiotics
possible surgery
how do you decide what antibiotics to treat a patient that has IE
depends on the;
microorganism isolated
sensitivities
resistance
Now compared to a few decades ago, who are the patients that get infective endocarditis
those with prosthetic valves MVP bicuspid aortic valve congenital heart disease IVDA immunocompromised
what are non-cardiac risk factors for IE
IVDA indwelling medical device diabetes mellitus chronic skin infections GI infections alcoholic cirrhosis
what can cause disruption of valve endothelium which in turn can lead to IE
turbulent blood flow electrodes catheters inflammation rheumatic carditis degenerative diseases
what symptoms would create high suspicion of IE
fever new murmur new conduction disorder pyrexia prosthetic material exposure to a IE organism previous IE congenital heart disease immunocompromised
what investigations would you do for IE
full bloods -CRP -ESR blood cultures urinalysis U+E CXR ECG Echo
what organisms are 85% of IE cases due to
stretococci
enterococci
staphylococcus
name two types of enterococci
faecalis
faecium
what is the Duke criteria used for
to diagnose IE
what are the two requirements in the major criteria
identifying organism
providing evidence of infection anywhere within the heart
what does the duke minor criteria focus on
clinical findings that could present in endocarditis
how long would you continue antibiotic treatment for native valve IE
4 weeks
what organisms commonly infect native valves in IE
staphylococci
streptococci
HACEK species
Bartonella spp
how long would you continue antibiotic treatment for prosthetic valves
6 weeks
what antibiotics would be used for native valve IE
IV gentamicin
and IV amoxycillin (or IV vancomycin)
what antibiotic would be used for native valve septis IE
Gentamicin
vancomycin
what antibiotics would you use for prosthetic valve IE
gentamicin
vancomycin
and rifampiein
what groups of patients are most likely to get fungi IE
PV
IVDA
immunocompromised
what is the treatment for fungi IE
dual anti-fungals
valve replacement
what two fungi can cause IE
candida
aspergillus
what is the most seer form of IE
PVE
what are the cardiac conditions at highest risk of IE
acquired valvular heart disease valve replacement structural congenital heart disease hypertrophic cardiomyopathy previous IE
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
