Infective Endocarditis

Question 1

Prototypic lesion of IE

Answer 1

Vegetations

Question 2

MC location of IE

Answer 2

Heart valves (native or prosthetic)

Question 3

In NVE, infections are greatest during?

Answer 3

1st 6-12 months after valve replacement

Question 4

Etiology of Community-acquired NVE via oral cavity

Answer 4

Viridans strep

Question 5

Etiology of Community-acquired NVE via skin

Answer 5

Staphylococci

Question 6

Etiology of Community-acquired NVE via Upper Respiratory Tract

Answer 6

HACEK

Question 7

Etiology of Health care-associated NVE

Answer 7

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

Question 8

Prosthetic valve endocarditis (PVE)

Answer 8

Within 2 months of surgery

Question 9

Etio of PVE 2-12 months after surgery

Answer 9

CoNS

Question 10

Etio of PVE >12 months after surgery

Answer 10

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

Question 11

Commonly affected valves in CIED-associated endocarditis

Answer 11

Aortic

Mitral

Question 12

MCC of CIED-associated endocarditis

Answer 12

MRSA or methicillin-resistant CoNS

Question 13

MC site of Endocarditis among IV drug users

Answer 13

Right sided

Tricuspid valve

Question 14

MCC of IV drug user-associated endocarditis

Answer 14

S.aureus

If left-sided: Pseudomonas, Candida

Question 15

Pre existing cardiac conditions predisposing to NBTE

Answer 15

AR
MR
AS
VSD

Question 16

Endocarditis caused by hypercoagulable states

Answer 16

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

Bland vegetations complicating SLE and APAS

Question 17

Cause of new regurgitant murmur

Answer 17

Due to valvular damage or ruptured chordae

Question 18

Endocarditis with blunted fever

Answer 18

Elderly
Severly debilitated
Renal failure

Question 19

Rapid progression of HF is due to

Answer 19

Aortic valve dysfunction (more than MV dysfunction)

Question 20

Nonsuppurative peripheral manifestations of SBE and related to prolonged infection

Answer 20

Janeway lesions

Question 21

Septic embolization manifesting as subungual hemorrhage in S.aureus endocarditis

Answer 21

Osler’s nodes

Question 22

Highest risk of embolization

Answer 22

S.aureus
vegetations >10mm
mitral valve location

Question 23

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

Answer 23

Mycotic aneurysms

Question 24

Definite IE based on Duke criteria

Answer 24

2 major
or
1 major + 3 minor
or
5 minor

Question 25

Possible IE based on Duke criteria

Answer 25

1 major + 1 minor or 3 minor

Question 26

Diagnosis is rejected if

Answer 26

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

Question 27

Blood culture protocol

Answer 27

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

Question 28

Noninvasive and SPECIFIC echocardiography in IE

Answer 28

Transthoracic

Question 29

Safe and more SENSITIVE echo

Answer 29

Transesophageal

Question 30

Major Criteria for IE

Answer 30

Positive blood culture | Evidence of endocardial involvement

Question 31

Minor criteria in IE

Answer 31

``` Fever Immunologic phenomena Vascular phenomena Predisposition Microbiologic evidence ``` (FIVe PM)

Question 32

Positive blood culture

Answer 32

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

Question 33

Positive Echocardiogram

Answer 33

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

Question 34

Treatment for penicillin-susceptible strep

Answer 34

Pen G x 4 weeks Ceftriaxone x 4 weeks Vancomycin x 4 weeks Pen G/Ceftri + Genta x 2 weeks

Question 35

Treatment for relative and moderately pen-resistant strep

Answer 35

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

Question 36

Treatment for enterococci

Answer 36

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

Question 37

Treatment for Methicillin-susceptible staph

Answer 37

Nafcillin or Oxacillin x 4-6 weeks Cefazolin x 4-6 weeks Vancomycin x 4-6 weeks

Question 38

Treatment for Methicillin-susceptible staph with prosthetic valves

Answer 38

``` Nafcillin/Oxacillin x 6-8 weeks + Genta x 2 weeks + Rifampin x 6 weeks ```

Question 39

Treatment for Methicillin-resistant staph

Answer 39

``` Vanco x 6-8 weeks + Genta x 2 weeks + Rifampin x 6-8 weeks ```

Question 40

Treatment for HACEK organisms

Answer 40

Ceftriaxone x 4 weeks or Ampi-Sulbactam x 4 weeks

Question 41

Major indication for cardiac surgical treatment of endocarditis

Answer 41

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

Question 42

MCC of perivalvular infection

Answer 42

Aortic Valve

Question 43

Indications for emergent surgical intervention

Answer 43

Acute aortic regurgitation plus preclosure of MV Sinus of Valsalva abscess ruptured into right heart Rupture into the pericardial sac

Question 44

Prophylaxis indication

Answer 44

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