Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiovascular system > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

what is the definition of endocarditis?

A

infection involvong the endocardal layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

which sites of the endocardium can be infected in IE?

A 
valvular structures (natuve or prosthetic)
chordae tendinae
septal defects
mural endocardium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the mortality for IE?

A

15-30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

is IE more common in males or females?

A

males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

does IE have a worse prognosis in males or females?

A

Females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the health professionals involved in the care of IE patients?

A

Frontline /referring Doctors-Acute physicians/GPs
Cardiologist-Diagnostics
Microbiologist/Infectious disease team
Cardiothoracic surgeon
Radiologist
Neurologist /Neurosurgeons (for embolic events)
Reference centre(complicated Infective endocarditis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

which groups of patient is IE seen in presently?

A
  • Older patients with degenerative heart disease ( Aortic Stenosis)
  • Healthcare –associated procedures
  • Intra cardiac devices (ICD)
  • Valve disease( Mitral valve prolapse, Bicuspid aortic valve)/Congenital heart disease
  • Prosthetic valve
  • IVDU
  • Immunocompromised patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the risk factors for native valve IE?

A 
Mitral valve disease
Rheumatic heart disease
Congenital heart disease
Degenerative  heart disease
Asymmetrical septal hypertrophy
Intravenous Drug abusers
Alcoholic cirrhosis
Diabetic mellitus
Indwelling medical devices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

which mitral valve disease increases the risk of IE?

A

mitral valve prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

which congenital heart diseases increase the risk of IE?

A

Ventricular septal defect
Bicuspid aortic valve
Patent ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

describe the pathophysiology of IE from endothelial disruption?

A

Normal valve endothelium is resistant to colonization and infection.

Mechanical endothelial disruption exposures extracellular matrix protein → production of tissue factors.
Deposition of fibrin and platelets→ Non-bacterial thrombotic endocarditis (NBTE).
NBTE facilitates bacterial adherence and infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what can cause damage to the endothelium of heart valves causing possibly causing IE?

A 
Turbulent blood flow (Venturi effect-low pressure)
Electrodes
Catheters
Inflammation (rheumatic carditis)
Degenerative valve disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

describe the pathophysiology of IE from inflammation?

A

Endothelial inflammation without valve lesion may promote IE.

  1. Inflammation of endothelial cell → expression of integrins (β1 family)
  2. Integrins are transmembrane protein-binds circulating fibronectin to endothelial surface.
  3. Staph aureus (other IE pathogens) carry fibronectin → binding proteins on their surface.
  4. Adherent organisms trigger active internalization into valve endothelial cells.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

which invasive procedures can cause bacteraemia leading to IE?

A
  • Dental procedures requiring manipulation( gingival /periapical region
  • Dental procedures -perforation of oral mucosa
  • GU and GI surgery
  • Intravascular catheters
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

which non-invasive activities can cause bacteraemia leading to IE?

A

(chewing and tooth brushing)-low grade bacteraemia of short duration but with high incidence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what general things can cause bacteraemia leading to IE?

A
  • invasive procedures (eg. dental procedures)
  • extra-cardiac infections
  • non-invasive activities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the main causative organisms of IE?

A 
Viridans group streptococci
Staphylococcus aureus
 Enterococci 
Coagulase-negative staphylococci
 Haemophils  parainfluenzae
 Actinobacillus 
Streptococcus bovis
Fungi
Coxiella burnetii, 
Brucella species, 
Culture-negative Haemphilus species, Actinobacillus,actinomycetemcomitans, Cardiobacterium hominis, eikenella corrodens and Kingella species (HACEK)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how can IE be classiified?

A
  • Acute(days/weeks) or subacute(weeks to months)
  • Nidus(localization) of infection± intra-cardaic material
  • Mode of acquisition (IVDU, Healthcare or community)
  • Active Infective endocarditis
  • Recurrence (relapse or reinfection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how can IE be classified according to localization?

A
  • left-sided native valve IE
  • left-sided prosthetic valve IE (PVE) (early <1 year after surgey, late >1 year after surgery)
  • right-sided IE
  • device related IE (permanent pacemaker or cardioverter-defibrillator)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how can IE be classified according to mode of acquisition?

A
  1. Health-care associated IE: nosocomial (signs/symptoms after 48hrs in hospital) and non nosocomial (signs/ symptoms less than 48hrs in hospital and residient in nursing home, long-term care facility, hospitalised <90 days earlier, home nursing or IV therapy, haemodialysis or IV chemotherapy)
  2. Community-acquired IE- signs in hospital < 48hrs after admission and not fulfillig criteria above
  3. IVDA IE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is active IE?

A

-IE with persistant fever and positive blood cultures
-active inflammatory morphology found at surgery
-patient stillunder antibiotic therpy
histopathological evidence of active IE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the classifications of recurrent IE?

A

relapse- same infection microorganism < 6months aftere initial episode
reinfection- infection with different microorgansim or same microorganims but >6monthd after initial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

is the presentation of IE consistent or varied?

A

varied

24
Q

which patients have an atypical presentation in IE?

A

elderly

immunocompromised

25
Q

what are the signs of acute IE?

A
  • fever
  • embolic signs/symtpoms
  • decompensated (functional deterioration when healthy before) HF
26
Q

what are the signs of subacute IE?

A
  • fever
  • non-specific constitutional symptoms or palpitation
  • immunologic/vascular phenomena.
27
Q

what are the common symptoms of IE?

A 
Fever/chills
Night sweats, malaise, fatigue, anorexia, weight loss
Weakness
Arthralgia
Headache
Shortness of breath
28
Q

what are constitutional symptoms?

A

a group of symptoms that can affect many different systems of the body.

29
Q

what are rhe clinical signs of IE?

A 
Cardiac murmur (regurgitant murmur) with signs of heart failure
Janeway lesions
Osler nodes
Roth spot
Meningeal signs 
Splinter haemorrhage
Cutaneous infarcts
Vasculitic rash
30
Q

which signs of IE are from immune complex deposition?

A

Osler nodes

Roth spots

31
Q

what are Janeway lesions ?

A

Haemorrhagic ,macular, painless plaques with predilection for palms and soles.

32
Q

what are Osler nodes?

A

Small ,painful nodular lesion found on pads of fingers or toes

33
Q

what will lead you to suspect IE?

A
  1. new regurgitant murmur
  2. embolic events of unknown origin
  3. sepsis of unknown origin (esp. if IE causative organism)
  4. fever with:
    - intracrdiac material
    - previous history of IE
    - other predisposition to IE (immunocompromised, IVDA)
    - predisposition and recent intervantion with associated bacteraemia
    - evidence of congestive heart failure
    - new conduction disturbance
    - positive blood cultures with typical IE causative organisms or positive serology for hronic Q fever
    - vascular or immunological phenomena: embolic event, Roth spots, splinterhaemorrhages, Janewya lesions, Osler’s nodes
    - foval or non-specific neurological symptoms or signs
    - evidence of pulmonary embolism/infiltration (right sided IE)
    - peripheral abscesses (renal, splenic, cerebral, vertebral) of unknown cause
34
Q

what are the investigations for IE?

A

-Blood culture- Timing. 3 sets and sites 30mins apart. +/- cultures
-FBC.ESR/CRP- elevated acute inflammatory makers
-U+Es- renal failure
-Urinalysis- +ve for blood
-ECG: PR interval prolongation ≥200ms
-CXR: Pulmonary congestion or abscess.
Further Imaging for subgroups – MSCT,MRI,18F-FDG -PET/CT and Leucocyte SPECT/CT –detect silent vascular phenomena/ endocardial lesions
-Echocardiography ( transthoracic (TTE) ± transesophageal (TOE)

35
Q

why are FBC and CRP blood tests carried out for in IE?

A

elevated acute inflammatory markers

36
Q

why are U+Es carried for IE?

A

to look for renal failure caused by embolic events

37
Q

why is an ecg carried out in IE?

A

to look for prolongation of PR interval

38
Q

why is CXR carried out for IE?

A

look for pulmonary abscess or congestion

39
Q

what are the 2 major ESC 2015 Modified Duke’s criteria for IE?

A
  • Blood cultures positive for IE

- imaging positive for IE

40
Q

for blood cultures to be positive for IE what must the result be?

A
  • Typical microorganisms consistent with IE from 2 separate blood cultures:
  • Microorganisms consistent with IE from persistently positive blood cultures:
  • Single positive blood culture for Coxiella burnetii or phase I IgG antibody titre >1:800
41
Q

what are are the imaging results that can be used for a positive diagnosis of IE?

A
  1. Echocardiogram positive for IE:• Vegetation
    • Abscess, pseudoaneurysm, intracardiac stula
    •Valvular perforation or aneurysm
    • New partial dehiscence of prosthetic valve
  2. . Abnormal activity around the site of prosthetic valve implantation detected by 18F-FDG PET/CT (only if the prosthesis was implanted for >3 months) or radiolabelled leukocytes SPECT/CT.
  3. Definite paravalvular lesions by cardiac CT.
42
Q

what are the minor criteria in ESC 2015 Modified Duke’s Criteria?

A
  1. Predisposition such as predisposing heart condition, or injection drug use.
  2. Fever defined as temperature >38°C.
  3. Vascular phenomena (including those detected only by imaging): major arterial emboli, septic pulmonary infarcts, infectious (mycotic) aneurysm, intracranial haemorrhage, conjunctival haemorrhages, and Janeway’s lesions.
  4. Immunological phenomena: glomerulonephritis, Osler’s nodes, Roth’s spots, and rheumatoid factor.
  5. Microbiological evidence: positive blood culture but does not meet a major criterion as noted above or serological evidence of active infection with organism consistent with IE.
43
Q

what is the combinations of major and minor criteria for definite IE diagnosis?

A

2 major
1 major + 3 minor
5 minor

44
Q

what is the combinations of major and minor criteria for possible IE diagnosis?

A

1 major + 1 minor

3 minor

45
Q

what must be considered before treatment of IE is given?

A
  • 3 sets of blood culture
  • whether patient has had previous antibiotic therapy
  • native or prosthetic valve
  • place of infection (community etc) and local epidemiology for antibiotic resistance and specific genuine culture negative pathogens
46
Q

what are the 3 antibiotics given in community-acquired native valve or late (>12 months post surgery) prosthetic valve endocarditis (not penicillin allergic)?

A 
ampicillin
with
flucloxacillin, cloxacillin or oxacillin
with
gentamicin
47
Q

what are the 2 antibiotics given in community-acquired native valve or late (>12 months post surgery) prosthetic valve endocarditis ( penicillin allergic)?

A

vancomycin
with
gentamicin

48
Q

what are the 3 antibiotics given in for ealry PVE or nosocomial and non-nosocomial healthcare associated endocarditis?

A 
vancomycin
with
gentamicin
with
rifampin (3-5 days later)
49
Q

what are the patient characteristic which can be used to predict a poor outcome in IE?

A

older age
prosthetic valve IE
dibetes mellitus
comorbidity

50
Q

what are the clinical complications of IE which can be used to predict a poor outcome?

A 
heart failure
renal failure
more than a moderate area of ischaemia stroke
brain haemorrhage
septic shock
51
Q

which microorgansims cause a poor outcome in IE?

A

staph aureus
fungi
non-HACEK gram negative bacilli

52
Q

what are the echo findings which can predict a porr outcome of IE?

A 
periannular complications
severe left-sided valve regurgitation
low left ventricular ejection fraction
pulmonary hypertension
large vegetations
severe prosthetic valve dysfunction
premature mitral valve closure and other signs of elevated diastolic pressures
53
Q

what are the complications and indications for srugery in IE?

A

heart failure- (valvular regurg.)
uncontrolled infection (perivavular abscess)
prevention of systemic embolisation (migration of cardiac vegetation to brain/spleen from left IE

54
Q

which patients are given prophylaxis for IE?

A
  1. patients with any prosthetic valve
  2. patients with a previous episode of IE
  3. patients with CHD:
    a) cyanotic CHD
    b) any type of CHD repaired with prosthetic material up to 6 months after procedure. (lifelong if residula vegetations of shunt)
55
Q

what are the preventative measures for IE?

A
  • Strict dental and cutaneous hygiene. Dental follow-up twice a year.
  • Disinfection of wounds.
  • Eradication or decrease of chronic bacterial carriage :skin, urine etc
  • Curative antibiotics for any focus of infection.
  • No self-medication with antibiotics.
  • Strict infection control measures for any at-risk procedures.
  • Discourage piercing and tattooing.
  • Limit the use of infusion catheters and invasive procedures when possible.

Cardiovascular system (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions