Infective Endocarditis

Question 1

Risk factors

Answer 1

NVE:
PVE:

Question 2

incidence

Answer 2

1.7/100,000 person years

increasing (?age, IVDU, PPx)

Question 3

symptoms

Answer 3

malaise, sweats, fever, anorexia, weight loss

???emboli, SOB, pain

Question 4

signs

Answer 4

new onset murmur, splenomegaly

vascular: petechiae, Janeway, splinter hge
immunological: Osler’s, Roth spots,

Question 5

common bacteria

Answer 5

strep viridans
enterococci
staph: aureus (MS/MR), epi
HACEK
cox?

Question 6

pathophysio

Answer 6

damage -> platelet and fibrin
NB????
bacterial colonisation, platelets, fibrin -> mature vegetation (protected)
calcification, fibrosis, distortion

Question 7

complications

Answer 7

heart failure
embolic events: CVA, spleen, kidneys, pulmonary abscess
GN (immune complexes)
???

Question 8

echo indications/choice

Answer 8

add

Question 9

Duke’s criteria (Y/?/N)

Answer 9

definite: 2 major; 1 major + 3 minor; 5 minor
possible: 1 major + 1 minor; 3 minor
rejection: other Dx, failed criteria

Question 10

major criteria

Answer 10

positive B/C (2/2 or 3/3 or 3/4; 12h/1h apart, separate sites)
echo

Question 11

minor criteria

Answer 11

high fever >38???
???
vascular
immunological
???

Question 12

investigations

Answer 12

FBC, CRP, EUC
UA, CXR, ECG
B/C
Echo (TTE -> TOE)

Question 13

antibiotics regime

Answer 13

4 weeks
empirical NVE: amoxicillin/benpen +/- gent
empirical PVE: vanc + gent + rifampicin
empirical acute: fluclox (likely staph)

Question 14

antibiotics choices

Answer 14

NVE:
NVE (sepsis):
NVE (?Pseudo/Entero):
PVE:

Question 15

alternative ABx

Answer 15

add (resistance/allergy)

Question 16

prognosis

Answer 16

5-50% mortality
30% mortality with staph
???more

Question 17

surgery indications

Answer 17

heart failure, ABx failure, severevalve dysfunction
supporation/abscess, 2+ embolic events
PVE, large L vegetation (emboli risk)
fungal/uncontrolled infection, pulmonary oedema/shock