Infective Endocarditis

Question 1

PATHOLOGY: Infective Endocarditis

Answer 1

• Infection of endothelium
• Usually valves (can be any cardiac structure)
• Vegetations mixture of bacteria + fibrin + platelets

Question 2

CAUSES: Infective endocarditis

Answer 2

Bacterial positive

• Strep. viridans
  
  • Found in mouth (most commonly linked with poor dental hygiene)
• Staph. epidermis
  
  • Prosthetic valves
• Staph. aureus*
  
  • IVDUs
• Staph. bovis
  
  • Colorectal cancer

Bacterial Negative

• Haemophillus
• Actinobacillus
• Cardiobacterium Hominis
• Eikenella
• Non-infective*
• SLE

Question 3

CLINICAL FEATURES: Infective Endocarditis

Answer 3

Peripheral

• SKIN: Petechial, Janeway lesions, splinter haemorrhage, Osler’s node
• EYES: Conjuntival splinter haemorrhages

Central

• CARDIAC: Murmurs, Heart failure
• NEURO: Cerebral emboli

Other

• Haematuria
• Malaise
• Clubbing
• Pyrexia
• Splenomegaly

Question 4

What scoring system is used for infective endocarditis?

Answer 4

MODIFIED DUKE’S CRITERIA

Question 5

INVESTIGATIONS: Infective Endocarditis

Answer 5

Culture

• Blood (minimum of 3)

Bloods

• FBC, CRP, ESR, Rheumatoid Facotr

Imaging

• ECG, Echo

Question 6

MANAGEMENT: Infective Endocarditis

Answer 6

Broad spectrum antibiotics

• Generally: benzylpenicillin + gentamicin
• Add flucloxacillin for IVDUs

Question 7

COMPLICATIONS: Infective endocarditis

Answer 7

• Septic emboli
• Mycotic aneurysms
• Meningitis
• Intracranial haemorrhages
• Emboli
• Glomerulonephritis