Infective endocarditis Flashcards

1
Q

What is the definition of infective endocarditis?

A

Endovascular infection of the cardiac structures including cardiac vales, atrial and ventricular endocardium and intracardiac foreign bodies e.g. prosthetic valves, pacemaker leads etc.

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2
Q

How common is infective endocarditis?

A

Annual UK incidence is 6-7/100,000 but more common in developing countries. ↑↑ mortality and morbidity rate. Aortic and mitral valves most commonly involved

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3
Q

What is the pathophysiology of infective endocarditis?

A
  • 2 main factors contribute to acquiring endocarditis: organisms in the bloodstream and abnormal cardiac endothelium
  • Damaged endocardium = platelet and fibrin deposition to which organisms adhere and grow → infective vegetation
  • α-haemolytic viridans streptococci – most common from mouth
  • Staph aureus – IVDU
  • Modified Duke criteria used to diagnose endocarditis
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4
Q

What is the aetiology/risk factors of infective endocarditis?

A
  • Poor dental hygiene/dental treatment
  • IV drug user – right sided lesion more common
  • IV cannula
  • Soft tissue infections
  • Cardiac surgery
  • Pacemaker
  • Prior antibiotic therapy – culture negative endocarditis
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5
Q

What are the signs/symptoms of endocarditis?

A
  • Fever
  • Malaise
  • Janeaway lesions
  • Splinter haemorrhages
  • Conjunctival haemorrhages
  • Clubbing
  • Oslers nodes – palmar side of hand
  • Petechiae
  • Roth spots (eyes)
  • Cardiac murmur
  • Cardiac failure – ventricular arrhythmias/conduction disturbances
  • Splenomegaly
  • Haematuria
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6
Q

What diseases present similarly to infective endocarditis?

A
  • SLE
  • Cardiac tumour
  • Lyme disease
  • Antiphospolipid syndrome
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7
Q

What investigations are carried out for suspected infective endocarditis?

A
  • Blood culture, microscopy and specificity – 3 sets from different venepuncture sites
  • Serological test for Q fever – IgG antibodies
  • FBC - ↓ Hb, ↑ WCC
  • U&Es - ↑ urea and creatinine
  • LFTs - ↑ serum alkaline phosphatase
  • ESR/CRP - ↑
  • Urinalysis – protein and blood present
  • CXR – pulmonary oedema in left side and pulmonary emboli/abscess in right side
  • Echocardiography – shows mass on the valve, implanted material or abscess
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8
Q

What are the surgical treatments for infective endocarditis?

A

valve replacement surgery - if the valve is destroyed

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9
Q

What are the pharmacological treatments for infective endocarditis?

A

• Prolonged antibiotics (normally 4-6 weeks) – almost always involves penicillin so beware of allergy

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