Infective endocarditis

Question 1

What is infective endocarditis

Answer 1

Infection CV structure - valves, endocardium, large intrathoracic vessels + foreign bodies (prosthetics + pacemakers)

Question 2

What causes it

Answer 2

• Bacteraemia
• Staph aureus (most common w. prosthetic valves, acute IE, IV drug use IE)
• Strep viridans
• Rarely –> haemophilus, actinobacilus etc.
• Fungi = candida + aspergillus
• SLE + malignancy

Question 3

What’s the difference between occurence on normal + prosthetic valves

Answer 3

• Normal = Run on acute course

- Abnormal = subacute course

Question 4

What are the symptoms

Answer 4

• Low grade fever + non-specific symptoms

Question 5

What are the signs

Answer 5

• Fever, new murmur = endocarditis till proven
• JANEWAY LESIONS, OSLER’S NODES, SPLINTER HAEMORRHAGES, ROTH SPOTS
• Septic signs
• cardiac lesions - new murmurs/ change in existing –> vegetations cause valve destruction –> sev regurg or obstruction
• Embolic events –> embolus may abscess in relevant organ

Question 6

What investigations

Answer 6

• BLOODS - 3 sets at different times from different sites
• DUKE CRITERIA for IE
  = Maj = 2 +ve blood culture + new murmer/echo

Question 7

What is the treatment

Answer 7

Staph = flucloxacillin + gentamicin

Strep = Benzylpenicillin, then amoxicillin + gentamicin

Enterococci - ampicillin/ amoxicillin + gentamicin

Surgery