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Foundations II (Cholley) > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

Define: Rheumatic fever

A

Systemic immune response after beta-hemolytic strep infection

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2
Q

Features of RF

A
  • Uncommon in US
  • Peak: 5-15 yrs
  • Self-limited carditis & valvulitis or progressive valvular deformity (MC = mitral)
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3
Q

RF: Minor criteria

A

“CAFE P”

  • CRP elevated
  • Arthralgia
  • Fever
  • ESR elevated
  • Prolonged PR
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4
Q

RF: Major criteria

A

“CANCER”

  • Carditis
  • Arthritis
  • Nodules
  • Chorea
  • Erythema margination
  • Rheumatic fever
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5
Q

RF: What is the DDx?

A
  • Rheumatoid arthritis
  • Osteomyelitis
  • Endocarditis
  • SLE
  • Lyme disease
  • Sickle cell anemia
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6
Q

RF: Dx tests

A
  • Echo
  • ECG
  • CRP/ESR
  • CBC
  • ASO
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7
Q

RF: Jones Criteria

A
  • 2 major criteria OR
  • 1 major & 2 minor OR
  • 3 minor (if recurrent)
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8
Q

Tx of RF

A
  • Supportive care
  • Salicylates
  • Penicillin
  • Corticosteroids
  • Education
  • Prevention of recurrences
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9
Q

RF: Px

A
  • Wks to mos in children
  • Mortality 1-2%
  • 30% of children die within 10 yrs
  • Persistent carditis = poor px
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10
Q

RF: Complications

A
  • Rheumatic valve disease
  • HF
  • Arrhythmias
  • Pericarditis w/ effusion
  • Rheumatic pneumonitis
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11
Q

RF: Referrals

A
  • Pediatric ID
  • Pediatric rheumatologist
  • Pediatric cardio
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12
Q

Define: Rheumatic heart disease

A

Permanent heart valve damage, subsequent to ARF

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13
Q

What is the major cause of CV disease in developing nations?

A

RHD

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14
Q

What does RHD cause?

A

Symptomatic valvular heart disease

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15
Q

RHD: Dx

A

TTE

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16
Q

RHD: Tx

A
  • Restrict activity
  • Tx complications
  • Prevent IE
  • Referrals as needed
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17
Q

Define: infective endocarditis

A

Microbial infection of valvular or endocardial surface of heart

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18
Q

IE: Classification

A
  • Native valve endocarditis
  • Prosthetic valve endocarditis
  • Injection drug users
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19
Q

Features of IE

A
  • Men > women
  • Pts over 60
  • Mortality 16-37%
  • Prosthetic valve endocarditis accounts for 10-30%
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20
Q

IE: Patho

A
  • Thrombus formation on endothelial surface
  • Bacteria circulates in bloodstream, infects site
  • Bacterial proliferation –> vegetations on endothelial surface
  • Valves involved
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21
Q

What valve is involved in native endocarditis?

A

Mitral, followed by aortic

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22
Q

What valve is involved in IDUs?

A

Tricuspid, followed by aortic

23
Q

What organism is most common in native valve endocarditis?

A

S. aureus

24
Q

What organisms are most common in prosthetic valve endocarditis?

A
  • S. aureus

- Coagulase- negative staphylococci

25
Q

What organisms are most common in intermediate-late endocarditis?

A
  • Streptococci

- S. aureus

26
Q

What organisms are most common in IDUs?

A
  • S. aureus (most frequent)
  • Streptococci
  • Enterococci (least frequent)
27
Q

IE: Cardiac involvement

A
  • More likely to have right-sided IE

- Tricuspid valve involved in 30-70%

28
Q

What are risk factors for IE?

A
  • Age > 60
  • Male
  • IDU
  • Poor dentition
  • Valvular disease
  • Congenital heart disease
  • Prosthetic heart valve
  • Hx of IE
  • Chronic hemodialysis
  • HIV
29
Q

What are sx of IE?

A
  • Fever
  • Cough
  • Dyspnea
  • Arthralgias/arthritis
  • Diarrhea
  • Abd/flank/back pain
30
Q

IE: What is seen on PE?

A
  • Fever
  • Regurgitant murmur
  • Peripheral lesions (petechiae, hemorrhages, osler nodes, janeway lesions, roth spots)
31
Q

What is the DDx of IE?

A

Bacteremia

32
Q

IE: Dx tests

A
  • Blood cultures
  • Echo
  • EKG
  • CXR
  • CT-torso
  • Modified Duke Criteria
33
Q

IE: Modified Duke Criteria (Definitive Dx)

A
  • 2 major criteria OR
  • 1 major & 3 minor OR
  • 5 minor
34
Q

IE: Modified Duke Criteria (Possible Dx)

A
  • 1 major + 1 minor

- 3 minor

35
Q

Features of bacterial endocarditis (“BE FIVE PM”)

A
  • Blood culture +
  • Endocardial involvement
  • Fever
  • Immunologic
  • Vascular
  • Echo findings
  • Predisposition
  • Microbial evidence
36
Q

What is the overall general tx for bacterial endocarditis?

A
  • Admit to hospital
  • Empiric tx covering staphylococci, streptococci, enterococci
  • Antimicrobial therapy (2-6 wks), monitor toxicity
  • Consult ID
  • +/- consult cardiac surgeon
37
Q

What meds are given to those w/ native endocarditis?

A

Vancomycin + Ceftriaxone

38
Q

What meds are given to those w/ prosthetic valve endocarditis?

A

Vancomycin + Rifampin + Gentamicin

39
Q

What meds are used to tx viridans streptococci?

A
  • Penicillin G IV x 4wks OR
  • Ceftriaxone IV x 4wks OR
  • 1 of the above + gentamicin IV x 2wks (Uncomplicated IE, rapid response to therapy, no underlying kidney disease)
40
Q

What meds are used for other forms of streptococci?

A
  • Penicillin IV x 4wks OR
  • Cefazolin IV x 4wks OR
  • Ceftriaxone IV x4wks
41
Q

What meds are used for enterococci?

A

Combo therapy, PCN + gentamicin
- Ampicillin IV or penicillin G IV x 4-6wks
+
- Gentamicin IV x 4-6wks OR ceftriaxone IV 4-6wks (CrCl < 50 or gentamicin restsitance)

42
Q

What meds do you use for staphylococci-methicillin- SUSCEPTIBLE S. aureus?

A
  • Nafcillin or oxacillin IV x 6wks OR

- Cefazolin IV x 6wks

43
Q

What meds do you use for staphylococci-methicillin- RESISTANT S. aureus?

A
  • Vancomycin IV x 6wks OR

- Daptomycin IV x 6wks

44
Q

What meds do you add to the tx of Staphylococci – methicillin- susceptible or resistant S. aureus if pt has prosthetic valve endocarditis?

A

Add rifampin x 6wks

Add gentamicin x 2wks

45
Q

What meds do you use to tx against HACEK organisms?

A

Ceftriaxone IV x 4wks

46
Q

What does HACEK stand for?

A
  • Haemophilus
  • Actinobacillus
  • Cardiobacterium
  • Eikenella
  • Kingella
47
Q

What is the general response to tx of endocarditis?

A
  • Improves in 3-4 days
  • Repeat blood cultures
  • Monitor relapse
48
Q

What does the f/u include for endocarditis?

A
  • Baseline eval
  • Dental eval
  • Drug rehab
49
Q

What are surgical indications of endocarditis?

A
  • Worsening CHF
  • Abscess
  • Infection w/ fungi
  • Staphylococci on prosthetic valve
  • Failure of antibiotic therapy
  • 2 major emboli or 1 major embolus w/ mobile vegetation
50
Q

When is prophylaxis of IE indicated, according to AHA?

A
  • Prosthetic valve
  • Previous IE
  • CHD
  • Heart transplant w/ valvulopathy
51
Q

What procedures require prophylaxis of IE, according to AHA?

A
  • All dental procedures, which involve manipulation of gingival tissue or periodical region of teeth or perforation of oral mucosa
  • Respiratory tract procedures, that involve incision of mucosa
  • Procedures on infected skin, skin structure, or musculoskeletal tissue
52
Q

What procedures DO NOT require prophylaxis?

A
  • Ear/body piercing
  • Tattooing
  • Vaginal delivery
  • Hysterectomy
  • Routine dental work
53
Q

What med are used for prophylaxis in dental & respiratory procedures?

A

Amoxicillin (most commonly)

Foundations II (Cholley) (25 decks)

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