Infective Endocarditis

Question 1

What is endocarditis?

Answer 1

Infection of the endothelial lining of the heart valves

Question 2

How does endocarditis arise?

Answer 2

Damaged heart valves produce turbulent flow over endothelium causing platelet/fibrin deposition upon which bacteria settles - producing vegetation over valves

Question 3

Causes

Answer 3

Bacteraemia (dental hygiene, IVDU), congenital, rheumatic disease, therapy (dental, IV), valve disease, organisms

Question 4

Typical organisms

Answer 4

Enterococcus, staph aureus, strep viridians, staph epidermis, MRSA

Question 5

Atypical

Answer 5

HACEK - Haemophilus, Actinobacillius,Cardiobacterium, Eikenella, Kingella
Coxiella burnetti, brucella, gram -ves, fungi

Question 6

S/S of endocarditis

Answer 6

FROM JANE
Fever, Roth spots, Oslers nodes, new Murmur, Janeway lesions, Anaemia, Nails (clubbing, splinter haemorrhages), Emboli
Also breathlessness + fatigue + weight-loss

Question 7

Immunological phenomena

Answer 7

Osler’s nodes, Roth spots

Question 8

Vascular phenomena

Answer 8

Janeway’s legions, splinter haemorrhages

Question 9

Investigations

Answer 9

3 sets of bloods from separate locations
Serology
CPR, inflammatory markers, FBC
ECHO - transthoracic/transoesophageal to look for vegetation

Question 10

Empirical native valve treatment

Answer 10

Amoxicillin + Gentamicin IV

Question 11

Empirical prosthetic valve treatment

Answer 11

Vancomycin + Gentamicin IV

Question 12

Staph aureus treatment

Answer 12

Flucoxacillin IV

Question 13

Strep viridians treatment

Answer 13

Penicillin + Gentamicin IV

Question 14

Staph epidermis treatment

Answer 14

Vancomycin IV + Gentamicin IV + Rifampicin PO

Question 15

MRSA treatment

Answer 15

Vancomycin IV + Gentamicin IV + Rifampicin PO

Question 16

Enterococcus treatment

Answer 16

Amoxicillin + Gentamicin IV

Question 17

Associated with IVDU

Answer 17

S. aureus

Question 18

Associated with poor dental hygiene

Answer 18

Strep viridians

Question 19

Associated with prosthetic valves

Answer 19

Staph epidermis

Question 20

Treatment of severe sepsis

Answer 20

Metropenem + Gentamycin

Question 21

Treatment of HACEK organisms

Answer 21

4 weeks - Amoxicillin

2 weeks - Gentamicin

Question 22

What scoring system is used for infective endocarditis?

Answer 22

Duke’s Criteria

2 major, 1 major+3 minor, 5 minor

Question 23

Duke’s criteria - major

Answer 23

2 separate blood cultures, endocardial involvement

Question 24

Duke’s criteria - minor

Answer 24

Fever, IVDU/predisposing HC, immunological phenomena, vascular phenomena, ECHO findings