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Cardiovascular > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

What is infective endocarditis?

A

Infection of the endocardium

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2
Q

What does infective endocarditis effect?

A

Heart valves
Interventricular septum
Chordae tendinae
Intra-cardiac devices

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3
Q

What is the outcome like for infective endocarditis?

A

Poor prognosis

High mortality

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4
Q

What effects the presentation of the disease?

A

Underlying cardiac disease
Microorganism involved
Presence/absence of complications
Underlying patient characteristics

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5
Q

Who is involved in the treatment of infective endocarditis?

A 
Primary care physician/acute medicine 
Cardiologist 
Surgeons 
Microbiologists 
Infectious disease doctors 
Neurologists 
Neurosurgeons 
Radiologists 
Pathologists
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6
Q

What is the incidence rate in the general population?

A

3-10 episodes per 100,000 people

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7
Q

What is the incidence rate amongst 70-80 year olds?

A

14.5 episodes per 100,000 people

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8
Q

Which gender is more at risk of developing the disease?

A

Men are two times more likely

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9
Q

Which gender has the worse prognosis?

A

Women

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10
Q

What are the cardiac risk factors?

A 
Mitral valve prolapse 
Ventricular septal defect
Aortic stenosis 
Rheumatic heart disease 
Prosthetic heart valve 
Cardiac surgery 
Prior native IE 
Cardiac surgery for native IE 
Surgery for prosthetic IE 
Congenital heart disease 
Aortic regurgitation 
Mitral regurgitation
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11
Q

What are the non-cardiac risk factors of IE?

A 
Injection drug usage 
Indwelling medical device 
Diabetes 
AIDs 
Chronic skin infections 
Burns 
Genitourinary infections or manipulations 
Alcoholic cirrhosis 
GI lesions 
Solid organ transplant 
Body lice 
Pneumonia 
Meningitis 
Infected animals
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12
Q

What are some common organisms responsible for IE?

A 
Staph aureus 
Strep pneumoniae 
Corynebacterium 
Enterococcus 
Neisseria gonorrhoeae 
Bartonella
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13
Q

What are the different modes of acquisition?

A

Health care related
Community acquired
Intravenous drug abuse

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14
Q

What are the signs and symptoms?

A 
Bacteraemic episodes 
Fever 
Fatigue 
Malaise 
Focal neurological signs 
Peripheral embolus/abscess 
Pulmonary embolus/abscess 
Immune complex deposition 
Congestive heart failure 
Murmurs
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15
Q

What are the immune complex depositions?

A 
Splinter haemorrhages 
Vasculitic rash 
Roth spots 
Osler's nodes 
Laneway lesions 
Nephritis
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16
Q

When can signs be absent?

A

Elderly
After antibiotic treatment
Immunocompromised
IE involving less virulent/atypical organisms

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17
Q

What investigations should be done?

A 
FBC 
CRP 
U+E's
ESR 
blood cultures 
Urinalysis 
ECG 
Chest X-ray 
Echo
18
Q

What are you looking for in a FBC?

A

Neutrophilic

19
Q

What are you looking for in U+E’s?

A

Nephritis
Infection
Sepsis

20
Q

How should the blood cultures be done before starting antibiotics?

A

3 sets at different sites with 6 or more hours between each

21
Q

How should the blood cultures be done to check for severe sepsis/septic shock?

A

2 sets at different sites within 1 hour of each other

22
Q

What are you looking for in urinalysis?

A

Positive for blood

23
Q

What are you looking for on an ECG?

A

Conduction delay

24
Q

What are you looking for on a CXR?

A

Heart failure

Pulmonary abscesses

25
Q

When should a transoesophageal echo be done?

A

Whenever there is a high suspicion of IE and if the transthoracic echo is abnormal

26
Q

When should there be a repeat TTE and TOE?

A

If there are new complications

In uncomplicated IE

27
Q

What are the 3 most common species of microorganism that cause IE?

A

Streptococci
Enterococci
Staphylococcus

28
Q

What are the different types of enterococci?

A

E.faecalis
E.faecium
E.durans

29
Q

What are the different types of staphylococcus?

A

S.aureus

S.epidermidis

30
Q

What are the major criteria of the modified Duke criteria?

A

Identifying organism

Providing evidence of infection anywhere within the heart

31
Q

What is the minor criteria of the modified Duke criteria?

A

Focus on the endocarditis complex of clinical findings

32
Q

What is the treatment of IE?

A

Antibiotics

Surgery

33
Q

What antibiotic are used if it affects native valves?

A

IV Gentamicin + Amoxycillin
or
Gentamicin + IV Vancomycin

34
Q

What antibiotics are used if it affects native valves and there is sepsis?

A

Gentamicin + IV Vancomycin

35
Q

What antibiotic are used if it affects prosthetic valves?

A

Gentamicin + IV Vancomycin + Rifampicin

36
Q

What fungi can cause IE?

A

Candida

Aspergillus

37
Q

What are the possible complications of IE?

A 
Heart failure 
Fistula formation 
Leaflet perforation 
Uncontrolled infection 
Abscess formation
Atrioventricular heart block 
Embolism 
Prosthetic valve dysfunction
38
Q

When should surgery be used to treat IE?

A

Intracardiac devices
Vegetation larger than 15mm
Embolism and vegetation larger than 10mm
When there are any complications

39
Q

When should prophylaxis be used?

A

On highest risk patients

40
Q

What is particularly important in terms of prophylaxis?

A

Good oral hygiene and regular dental reviews

Cardiovascular (34 decks)

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