Infective endocarditis

Question 1

If the patient has fever and a new murmur, what is highly suspected?

Answer 1

Infective endocarditis

Question 2

What are the main signs of infective endocarditis?

Answer 2

Fever
Night sweats
Weight loss
Anaemia
Splenomegaly
Clubbing
New or change in existing murmur
Splinter Haemmorhages
Janeway lesions (due to emboli)

Question 3

Which criteria is extremely useful in diagnosis of infective endocarditis?

Answer 3

Duke’s Criteria

Question 4

What are the major criteria involved in Duke’s criteria?

Answer 4

Positive blood culture
Positive echo
New valvular murmur

Question 5

What are the minor criteria involved in Duke’s criteria?

Answer 5

Predisposition to IE
Fever
\+ve blood culture not meeting major
\+ve echo not meeting major
Vascular signs (Janeway lesions)

Question 6

How many of the Duke’s criteria are needed to diagnose IE?

Answer 6

2 major
1 major and 3 minor
All 5 minor

Question 7

Which further tests could be used in diagnosing IE?

Answer 7

Blood tests (CRP, U+Es and LFT)
Urinalysis (Haematuria)
CXR (Cardiomegaly)
ECG (Long PR interval)
Echo (TTE + TOE, may show vegetation)

Question 8

What is the main management for IE?

Answer 8

Antibiotic therapy

Possible surgery

Question 9

What is needed to be done before antibiotics are given in IE?

Answer 9

Blood cultures

Question 10

If it is IE with a positive blood culture, what are the likely causative organisms?

Answer 10

Streptococci
Enterococci
Staph Aureus

Question 11

If it is IE with a negative blood culture, what are the likely causative organisms?

Answer 11

Oral streptococcus

Gram negative bacilli