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HPIM 19th ID > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

Prototypic lesion of IE

A

Vegetations

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2
Q

MC location of IE

A

Heart valves (native or prosthetic)

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3
Q

In NVE, infections are greatest during?

A

1st 6-12 months after valve replacement

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4
Q

Etiology of Community-acquired NVE via oral cavity

A

Viridans strep

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5
Q

Etiology of Community-acquired NVE via skin

A

Staphylococci

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6
Q

Etiology of Community-acquired NVE via Upper Respiratory Tract

A

HACEK

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7
Q

Etiology of Health care-associated NVE

A

S.aureus
CoNS (S.epidermidis, S.saprophyticus)
Enterecocci

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8
Q

Prosthetic valve endocarditis (PVE)

A

Within 2 months of surgery

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9
Q

Etio of PVE 2-12 months after surgery

A

CoNS

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10
Q

Etio of PVE >12 months after surgery

A 
Oral cavity: Viridans strep
Skin: Staphylococci
URT: HACEK
GIT: Streptococcus gallolyticus (bovis)
GUT: Enterecocci
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11
Q

Commonly affected valves in CIED-associated endocarditis

A

Aortic

Mitral

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12
Q

MCC of CIED-associated endocarditis

A

MRSA or methicillin-resistant CoNS

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13
Q

MC site of Endocarditis among IV drug users

A

Right sided

Tricuspid valve

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14
Q

MCC of IV drug user-associated endocarditis

A

S.aureus

If left-sided: Pseudomonas, Candida

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15
Q

Pre existing cardiac conditions predisposing to NBTE

A

AR
MR
AS
VSD

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16
Q

Endocarditis caused by hypercoagulable states

A

Marantic endocarditis (uninfected vegetations seen in patients with malignancy and chronic diseases)

Bland vegetations complicating SLE and APAS

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17
Q

Cause of new regurgitant murmur

A

Due to valvular damage or ruptured chordae

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18
Q

Endocarditis with blunted fever

A

Elderly
Severly debilitated
Renal failure

19
Q

Rapid progression of HF is due to

A

Aortic valve dysfunction (more than MV dysfunction)

20
Q

Nonsuppurative peripheral manifestations of SBE and related to prolonged infection

A

Janeway lesions

21
Q

Septic embolization manifesting as subungual hemorrhage in S.aureus endocarditis

A

Osler’s nodes

22
Q

Highest risk of embolization

A

S.aureus
vegetations >10mm
mitral valve location

23
Q

Focal dilations of arteries occuring at points in the artery wall that have been weakened by infection in the vasa vasorum or where septic emboli have lodged

A

Mycotic aneurysms

24
Q

Definite IE based on Duke criteria

A 
2 major
or
1 major + 3 minor
or
5 minor
25
Q

Possible IE based on Duke criteria

A

1 major + 1 minor
or
3 minor

26
Q

Diagnosis is rejected if

A

Alternative diagnosis is established

Symptoms resolve and do not recur = 4 days of antibiotics

Surgery or autopsy after = 4 days of antibiotics yields no histologic evidence of endocarditis

27
Q

Blood culture protocol

A

If without prior antibiotics: 3 blood culture sets (2 bottles per set), separated from each other by at least 2 hours apart, from different venipuncture sites over 24 hours

28
Q

Noninvasive and SPECIFIC echocardiography in IE

A

Transthoracic

29
Q

Safe and more SENSITIVE echo

A

Transesophageal

30
Q

Major Criteria for IE

A

Positive blood culture

Evidence of endocardial involvement

31
Q

Minor criteria in IE

A 
Fever
Immunologic phenomena
Vascular phenomena 
Predisposition 
Microbiologic evidence

(FIVe PM)

32
Q

Positive blood culture

A

Typical microorganism for IE from 2 separate blood cultures

Persistently positive blood culture (cultures drawn 12h apart or 3 out of 4 with 1st and ladt drawn at least 1 hr apart

Single positive culture for Coxiella burnettinor phase I IgG antibody titer of >1:800

33
Q

Positive Echocardiogram

A

Oscillating intracardiac mass on valve or supporting structures or in the path of regurgitant jets or in implanted material, in the absence of an alternative anatomic explanation
or
Abscess
or
New partial dehiscence of prosthetic valves
or
New valvular regurgitation

34
Q

Treatment for penicillin-susceptible strep

A

Pen G x 4 weeks
Ceftriaxone x 4 weeks
Vancomycin x 4 weeks

Pen G/Ceftri + Genta x 2 weeks

35
Q

Treatment for relative and moderately pen-resistant strep

A

Relative: Pen G/Cefti x 4 weeks + Genta x 2 weeks

Moderate: Pen G/Cefti x 6 weeks + Genta x 6 weeks

Pen preferred for prosthetic valves

36
Q

Treatment for enterococci

A 
Pen G + Genta x 4-6 weeks
or
Ampi + Genta x 4-6 weeks
or
Ampi + Ceftri x 4-6 weeks (for E.faecalis)
37
Q

Treatment for Methicillin-susceptible staph

A

Nafcillin or Oxacillin x 4-6 weeks

Cefazolin x 4-6 weeks

Vancomycin x 4-6 weeks

38
Q

Treatment for Methicillin-susceptible staph with prosthetic valves

A 
Nafcillin/Oxacillin x 6-8 weeks
\+
Genta x 2 weeks
\+
Rifampin x 6 weeks
39
Q

Treatment for Methicillin-resistant staph

A 
Vanco x 6-8 weeks
\+
Genta x 2 weeks
\+
Rifampin x 6-8 weeks
40
Q

Treatment for HACEK organisms

A

Ceftriaxone x 4 weeks
or
Ampi-Sulbactam x 4 weeks

41
Q

Major indication for cardiac surgical treatment of endocarditis

A

Moderate to severe refractory CHF caused by new or worsening valve dysfunction

42
Q

MCC of perivalvular infection

A

Aortic Valve

43
Q

Indications for emergent surgical intervention

A

Acute aortic regurgitation plus preclosure of MV

Sinus of Valsalva abscess ruptured into right heart

Rupture into the pericardial sac

44
Q

Prophylaxis indication

A

only for patients at highest risk for severe morbidity or death (before dental procedures and surgery of respiratory tract)

Prosthetic heart valves
Prior endocarditis
Unrepaired CHD, including palliative shunts or conduits
Completely repaired CHD during the first 6 months of repair
Incompletely repaired CHD with residual defects adjacent to prosthetic material
Valvulopathy developing after cardiac transplantation

HPIM 19th ID (16 decks)

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