Infective Endocarditis Flashcards
What is bacteraemia?
Presence of bacteria in the bloodstream. also known as septicaemia.
What is infective endocarditis?
Infection of the endothelium of the heart Valves.
Can be life threatening
Acute or sub-acute
Predisposing factors for endocarditis?
- Heart valve abnormality
- congenital heart defects
- age related calcification/sclerosis
- post rheumatic fever - Metal valve
- IV drug users
- Intramuscular lines
Summarise the pathogenesis of endocarditis
- Damaged valves
- turbulent blood flow over rough endothelium
- fibrin and platelets deposits over endothelium
- transient bacteraemia (e.g. from dental treatment)
- bacteria settle on the platelets/thrombi
- microbial vegetation
How can the microbial vegetations lead to haemorrhages?
Infected vegetations may break off and occlude or completely block a vessel–> abscess or haemorrhage.
Usually left side affected
4 Most common bacteria causing endocarditis?
- Staph aureus
- Viridans streptococci
- Enterococcus sp
- Staph Epidermis
Some unusual organisms causing endocarditis?
Atypical- coxiella, mycoplasma, legionella etc
gram - = Haemophilus, cardiobacterium, kingella
Fungi
How do Staph aureus show up in Gram film?
Purple. Cocci in clusters
Where is Staph Epidermis normally found?
Skin contaminant. Can cause infection in prosthetic valves/ intramuscular lines.
Presenting symptoms of acute endocarditis?
- Overwhelming Sepsis
- Cardiac failure.
Subacute
- Fever
- Breathlessness
- Malaise
- Weight loss
- Tiredness
What are some signs of sub acute endocarditis
- Splinter haemorrhages
- Oslers nodes, Janeway lesions, Roth spots
- fever
- Murmurs
- Splenomegaly
- Clubbing
What test must be done to confirm endocarditis?
Blood culture of 3 sets to confirm causative organism.
If Negative- consider serology of atypical organisms
What are the causative organisms behind early presentations of endocarditis in prosthetic valve replacements?
Early- within 60 days of replacement
- Staph Epidermis
- Staph aureus.
Late- can be many years after. due to co-incidental bacteraemia. Wide range of causative organisms.
What is the treatment for native valve endocarditis?
Amoxicillin + Gentamicin IV
What is the treatment for prosthetic valve endocarditis?
Vancomycin + Gentamicin IV.
Rifampicin orally. Added 3-5 days after initial treatment
May need valve replacement.
Treatment for drug user endocarditis?
Flucloxacillin IV
What is the specific treatment for-
- Staph Aureus
- Staph Epidermis
- Enterococcus sp
- Viridans Strep?
- Staph Auereus- Flucloxacillin
- Staph Epidermis- Vancomycin, gent, rifampicin
- Enterococcus- Amoxicillin/vancomycin + gent
- Viridans- benzylpenicillin + gent
What are things to monitor over the treatment period?
DONT need to memorise
- IV antibiotics 4-6 weeks
- Check cardiac failure
- Tempertaure
- CRP levels
What is myocarditis?
Inflammation of the heart muscle.
Which type of people is this common in ?
Young. may result in sudden death.
What are the symptoms of myocarditis?
- Fever
- Chest pain
- Breathlessness
- Palpitations
What are the signs of myocarditis?
Arrhythmias and cardiac failure
What group of pathogens is myocarditis commonly caused by? Example?
Enteroviruses. Coxsackie A & B. Echovirus
What test is used for diagnosis?
Diagnosed by Viral PCR.
Throat swab + stool for enterovirus
Treatment- supportive
What is pericarditis?
Inflammation of the pericardium. commonly seen with myocarditis.
Main symptom of pericarditis?
Chest pain. Viral aetiology. Bacteria less common.
Same viral ones as for myocarditis.
Treatment -supportive.
