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Systems: Cardiovascular > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

What layer of heart is affected in endocarditis?

A

Endocardium

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2
Q

What is the prevalence of infective carditis?

A

3-10/100,000

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3
Q

What is the ratio of male to female?

A

2;1

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4
Q

What are the signs of infective endocarditis?

A
  • Splinter Haemorrhages
  • Vasculitic rash
  • Roth spots
  • Oslers Nodes
  • Janeway lesions
  • Nephritis
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5
Q

What is the pattern of vasculitic rash?

A
  • Diffuse
  • Non-Blanching
  • Petechial
  • Purpuric
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6
Q

What are roth spots?

A

-Retinal haemorrhages
-White/pale centre
=Coagulated fibrosis

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7
Q

What are oslers nodes?

A

-Deep, red spots
-Painful
-raised
-Finger pulps
(palm/soles)

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8
Q

What are Janeway lesions?

A
  • Flat, macular
  • Echymotic (escape of blood into the tissues from ruptured blood vessels)
  • Palms/soles
  • Nontender
  • Pathognomic (dead giveaway)
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9
Q

Where may the signs be absent?

A
  • elderly
  • After antibiotic treatment
  • Immunocompromised
  • IE Involving less virulent/atypical organism
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10
Q

What are the investigations for IE?

A
  • Markers of infection/inflammation
  • -FBC
  • -CRP
  • -ESR
  • U+E`s
  • Nephritis
  • infection
  • sepsis
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11
Q

What will be seen on an ECG?

A

-Conduction Delay

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12
Q

What will be seen on CXR?

A
  • Heart failure

- Pulmonary abscesses

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13
Q

What will be seen on an echocardiogram?

A

-Transthoracic

then Trans oesophageal

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14
Q

What are the causes of IE with -ve blood cultures?

A
  • Prior antibiotics reaction
  • fastidious organisms
  • Intracelluar bacteria
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15
Q

What 3 bacteria cause 85% of all IE?

A
  • Streptococci
  • Enterococci
  • Staphylococcus
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16
Q

Name the different strep infections?

A

-Oral (viridans) streptococci

-S.Milleri S.anginosus grp
Group D streptococci
Streptococcus bovis/equinus

17
Q

What are the different types of enterococci?

A

E.Fecalis
E.Faecium
E.durans

18
Q

What are the different types of Staphylcoccus?

A

S.Aureus
(health care associated)
-Coagulase negative staph (CNS) S.epidermidis

19
Q

What are the two reasons why blood cultures would be negative?

A
  • Prior antibiotic treatment
  • fastidious organisms
  • Intracelluar bacteria
20
Q

Name the fastidious organisms that can cause IE?

A
  • Nutritionally variant streptococci
  • Fastidious Gram -VE bacilli _HACEK grp (feckin loads)
  • Brucella
  • Fungi
21
Q

Name the intracelluar bacteria that can cause -ve blood cultures?

A

(5% of all IE)

  • Coxiella burnetii
  • Bartonella
  • Chlamydia
22
Q

What is the Major criteria using the modified Duke Criteria?

A
  • Identify organism

- Providing evidence of infection anywhere in the heart

23
Q

What is the minor criteria using the modified duke criteria?

A

-Focus on the endocarditis complex of clinical findings

24
Q

What is the modified Duke criteria for blood cultures positive for IE?

A
  • Typical organisms consistent with IE from 2 seperate blood cultures
  • Organisms consistent with IE from persistently positive blood cultures
  • Single +ve blood culture for coxiella burnetti
25
Q

What is the evidence of endocardial involvement using the modified Duke Criteria?

A
  • Positive echocardiogram

- New valvular regurgitation/murmur

26
Q

What is the minor criteria for the modified duke scale for IE?

A
  • Predisposition
  • Fever
  • vascular phenomena
  • Immulnologic phenomena
  • Microbiological evidence
27
Q

What is the main antibiotic group to choose when treating IE?

A

-Aminoglycosides synergies with cell wall inhibitor (beta lactams, glycopeptides)

28
Q

What do you treat native valves infected with?

A

IV Gentamycin
IV amoxycilllin

Potentially Vancomycin

29
Q

How do you treat native valves when sepsis also happens?

A
  • Gentamicin

- IV vancomycin

30
Q

How do you treat IE in prosthetic valves?

A
  • Gentamicin
  • Vancomycin
  • Rifampicin
31
Q

what are the side effects of gentamicin?

A
  • nephrotoxic

- Ototoxic

32
Q

When can Fungi cause IE?

A

-PVE
_Intra venous drug abuser
-Immunocompromised

33
Q

What are the two likely causes of fungal IE?

A
  • Candida

- Aspergillus

34
Q

What can be the complications of IE surgery?

A
  • heart failure
  • Fistula formation
  • Leaflet perforation
  • Uncontrolled infection
  • Abcess formation
  • atrioventricular heart block
  • Embolism
  • Prosthetic valve dysfunction
35
Q

What are the cardiac conditions that are at the highest risk of IE?

A
  • Acquired valvular heart disease
  • valve replacement
  • Structural congenital heart disease
  • Hypertrophic cardiomyopathy
  • Previous IE

Systems: Cardiovascular (31 decks)

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