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Nayla Foundations > Infective endocarditis > Flashcards

Infective endocarditis Flashcards

1
Q

What is infective endocarditis

A

microbial infection of valvular or endocardial surface of heart
Can be native valve, prosthetic valve, or IVDU

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2
Q

What happens during infective endocarditis

A

thrombus forms on the endothelial surface, bacteria infect the site and proliferate

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3
Q

What valves are involved in infective endocarditis

A

Native: mitral valve
Prosthetic: site of prosthesis
IDU: tricuspid (R sided), then aortic

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4
Q

What are the native IE infective organisms

A

S. Aureus

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5
Q

What are the prosthetic IE infective organisms

A

Early: S. aureus and Coag negative staph
Late: Streptococci and S. aureus

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6
Q

What are the IDU IE infective organisms

A

S. Aureus
Streptococci
Enterococci

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7
Q

What are risk factors for IE

A 
>60 y/o
male
IDU
Poor dentition 
HIV
chronic hemodialysis
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8
Q

What are symptoms of IE

A

fever, cough, dyspnea
Arthralgia’s
diarrhea, abd pain, back pain

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9
Q

What will you see on physical exam for IE

A

New regurgitant murmur

Petechiae, splinter hemorrhage, osler node (painful), Janeway lesions, roth spots

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10
Q

What are some differentials for IE

A

bacteremia (cath infection, skin cardiac prosthetic infection, osteomyelitis, meningitis, PNA, sepsis)

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11
Q

What diagnostic tests are the most important for diagnosing IE

A

blood cultures!
Also transthoracic echo (shows vegetation, abscess, or dehiscence)
TEE (higher sensitivity)
ECG, CXR, CT torso

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12
Q

What is the Major modified duke criteria

A
  • 2 positive blood cultures
  • Echo showing endocardial involvement
  • New regurgitant murmur
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13
Q

What is the Minor modified duke criteria

A
  • Predisposing condition
  • Fever >38 C
  • Vascular findings (aneurysm, emboli, pulm. infarct)
  • Immunologic findings (osler nodes, etc.)
  • Blood cultures not seeing major criteria
  • Serologic evidence of infection
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14
Q

What gives you a definitive IE diagnosis based on Duke criteria

A

2 major OR
1 major and 3 minor OR
5 minor

(possible diagnosis if 1 major 1 minor, or 3 minor)

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15
Q

What are the diagnostic criteria for bacterial endocarditis

A 
BE FIVE PM
B- blood culture +
E- Endocardial involvement 
F- fever
I- immunologic 
V- vascular 
E- echo findings
P- predisposition
M- Microbiologic evidence
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16
Q

How do you treat IE

A

admit to hospital
empiric treatment
consult infectious disease

17
Q

What is empiric treatment for IE

A

Vancomycin or Cephtriaxone

PV: Vancomycin + Gentamicin + Rifampin

18
Q

What is treatment for Strep Viridians

A 
Penicillin or Ceftriaxone (4 weeks) 
P or C plus Gentamicin (2 weeks)
PV: 
Penicillin or Ceftriaxone (6 weeks) 
P or C plus Gentamicin (2 weeks)
19
Q

What is the treatment for Other strep (not Viridans)

A

Penicillin
Cephazolin
Ceftriaxone

20
Q

What is the treatment for enterococci

A

Penicillin or Ampicillin
PLUS Gentamicin or Ceftriaxone
(PCN + gentamicin preferred)

21
Q

What is the treatment for MRSA

A

Vancomycin or Daptomycin

22
Q

What is the treatment for S. Aureus

A

Naficillin
Oxacillin
Cephazolin
PV: Add Rifampin or gentamicin

23
Q

What is the treatment for HACEK organisms

A

Ceftriaxone

24
Q

How long until you should see a response with treatment for IE

A

3-4 days

repeat blood cultures to monitor relapse

25
Q

What complications can occur with IE

A 
Cardiac 
Neurologic
Septic emboli
Metastatic infection 
Systemic immune reaction
26
Q

What are indications for IE surgery

A 
worsening CHF
abscess
fungal infection 
Staph on PV
Abx failure
2 major emboli
27
Q

What is prophylactic therapy for dental and respiratory procedures

A

Amoxicillin

28
Q

Who should receive prophylactic treatment

A

Prosthetic cardiac valve
previous IE
CHD
Heart transplant with valvuloplasty

29
Q

What cardiac conditions do NOT need prophylaxis

A

MVP, RHD, AS

30
Q

What procedures require prophylaxis

A

dental procedure involving gingiva (including cleaning)
incision of respiratory mucosa (tonsillectomy)
procedure on infected skin

Nayla Foundations (18 decks)

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