Infective Endocarditis Flashcards
what are the symptoms of IE?
fever, malaise, sweating, weight loss
chest pain
breathlessness
what are the sign of IE?
cardiac- fever, sweating, murmur, splinting hemorrhages
what is one of the main complications/other effects with IE?
can have distant embolic events- i.e. if a piece of the colony breaks off and is big enough it may occlude an artery/vein somewhere else
if you suspected an IE, what tests would you do?
blood cultures
echocardiography- can see the valves well here
what is the most common causing organism for IE and what is the source?
staph areas is the most common causing!
then coagulase negative staph: ie staph epidermidis - from contaminated IV lines (i.e. hickman)
what are the other common organisms causing IE?
staph aureus coliforms - UTI, bowel sepsis enterococci- UTI, bowel sepsis pseudomonas- UTI, catheter alpha hemo -strep pneumonia (from pneumonia) beta hemo strep
what criteria is used to diagnose IE?
duke’s criteria - 2 major + 1 minor, or 1 major + 3 minor
what are the 3 major criteria in dukes crtieria to diagnose IE?
new cardiac murmer/regurgitation/dehiscence of prosthetic valve
and
positive blood culture with organism commonly causing IE
positive echo for IE
name some of the minor criteria in dukes criteria of diagnosis of IE?
fever >38
embolic event - i.e. arterial embolic /pulmonary infarcts
known predisposing factor- IVDU for example
immunological problems: glomerularnephritis, roth’s spots, osler’s nodes
positive blood culture with organism consistent with IE but not in major criteria
what is the minimum amount of blood cultures needed to be taken to diagnose IE?
3 sets (6 bottles) of blood cultures, taken from different sites, an hour apart from each other
someone with suspected IE has small red marks on their nails- what are these and why do they occur?
splinter hemorrhages
microemboli migrating from the heart valve to the small capillaries in the fingers damages them causing tiny bleeds
are splinter haemorrhages specific to IE?
no, they can also occur in RA and SLE
how are dental procedures and IE related? and what should be done about it?
oral commensals, or if there is periodontal disease, then bacteria can get into the blood stream when brushing or when there is a dental procedure- this can lead to IE.
most dental procedures don’t need prophylactic antibiotics, but in those at high risk for IE (i.e. has valve replacement or have other congenital defects) may receive them.
staph epidermidis has normally quite low virulence. why can it cause IE then?
because in patents with prothetic /replaced valves (i.e. metal) gives it a location to sit and grow on
how do you normally treat IE?
find sensitivities of the bacteria
high dose of IV antibiotics
and a second antibiotic (for more penetrance) (i.e. synergistic gentomycin)
for extended period of time
