Infective Endocarditis

Question 1

Vegetation characteristics

Answer 1

Bulky & friable
Thrombotic debris + bacteria
Often with underlying cardiac tissue destruction

Question 2

Etiology

Answer 2

MCC= Pyogenic bacteria

Other: Fungi, Rickettsia, Chlamydia

Question 3

ABE characteristics

Answer 3

Highly destructive, normal valve
Organism: St aureus or Gram negative
Prognosis: Death within days
Etiology: secondary to sepsis/bacteremia
Lesion: necrotizing, perforating

Question 4

SBE characteristics

Answer 4

Slower, less virulent, already abnormal valve
Organism: less virulent, St. viridans (Beta-hemolytic)
Prognosis: Weeks-months, most recover with ABX
Lesion: less destructive, may heal

Question 5

Pre-existing valve conditions

Answer 5

1. Prosthetic
2. Congenital defect
3. Degenerative calcified stenosis
4. Bicuspid aortic valve
5. MVP/Myxomatous MV

Question 6

Prosthetic organism

Answer 6

Staph epidermidis

Question 7

IVDA organisms

Answer 7

1. Staph aureus

2. Strept & Candida

Question 8

Other organisms

Answer 8

Enterococci, Gram neg, Fungi

Get cultures before empiric ABX therapy (10% don’t know)

Question 9

Clinical presentation

Answer 9

Fever=most consistent sign
ABE: quick onset, chills, night-sweats, weakness
SBE: low-grade fever, fatigue, flu-like sx
Murmur
Embolization signs

Question 10

Septic emboli complications

Answer 10

1/3 of patients–MC complication (MC area=brain)

1. Retinal: blind
2. Coronary: MI
3. Cerebral: stroke
4. Splenic
5. Pulmonary: IVDA
6. Renal: abscess or glomerulonephritis

Question 11

CHF complication cause

Answer 11

1. Valve destruction/tendinae rupture
2. MI
3. Myocardial abscess

Question 12

DX

Answer 12

1. Blood cultures needed to confirm (90% will be positive)
2. US of vegetation
3. Clinical presentation/complication

Question 13

IVDA characteristics

Answer 13

1. Tricuspid valve
2. Leads to pulmonary emboli/abscess–Pneumonia
3. Staph aureus- 50-60% of cases
4. Patho: bacteremia from cellulitis/phlebitis at injection site