infective endocarditis Flashcards
what is infective endocarditis?
infection of the endothelium of the heart valves
hospital acquired cases are increasing. These are particularly due to?
staph aureus
pre disposing factors for endocarditis ?
heart valve abnormalities (calcification and sclerosis in elderly, congee heart disease, post thematic fever)
prosthetic heart valves
IVDU
intravascular lines
pathogenesis of endocarditis?
heart valve damaged, turbulent blood flow over it, platelets and fibrin deposited, bacteraemia (e.g. from dental procedure), organisms settle in the fibrin/platelet clot, becoming a microbial vegetation
what happens to these infected vegetations?
they are friable and break off, becoming lodged in next capillary bed - cause access or haemorrhage
what side of the heart is usually affected?
left (oxygen)
organisms causing endocarditis in native valve?
staph aureus, viridian’s step, enterococcus and staph epidermidis
common pneumonic for signs and symptoms of endocarditis?
FROM JANE Fever Roth spots Osler nodes Murmur Janeway lesions Anaemia Nail Haemorrhage Emboli
Atypical organisms?
Bartonella, Burnetti, chlamydia, legionella, mycoplasma,brucella
How to diagnose?
take 3 sets of blood cultures. If they are all positive, this is good evidence of continuing bacteraemia.
what bacteria is often a skin contaminant, but can infect prosthetic material?
staph epidermidis
is staph epidermidis gram positive or negative?
negative (think its on your skin so pink skin)
is staph aureus gram positive or negative?
A+ (positive)
symptoms of endocarditis?
fever malaise weight loss tiredness breathlesness
what do you do if blood cultures negative but you suspect end?
consider serology for atypical organisms
what echocardiograms do you carry out?
first do transthoracic, then transoesophageal
early prosthetic valve infection usually due to?
SAureus or staph epidermidis
Treatment for endocarditis in a prosthetic valve?
Very Good Replacement
Vancomyin
Gentamycin
Rifampicin
what urinary symptoms do you get in endocarditis?
haematuria
what is the organism usually associated with right sided endocarditis ?
staph aureus
how do you treat IVDUs with right sided endocarditis?
flucloaxcilin
why do IVDUs get right sided ?
they inject into veins, goes into right side of heart first
when do you add in the rifampicin in a native valve endocarditis?
day 3-5
how do you treat enterococcus endocarditis?
Amox and gent (enter AG)
staph epidermidis?
would get this infection with a prosthetic valve. prosthetic valve( VGR)
how long are IV drugs given for?
4-6 weeks
what 3 things do you monitor?
cardiac function, temperature and CRP
myocarditis is more common in ?
young people
symptoms of myocarditis?
fever, chest pain, shortness of breath, palpitations
myocarditis mainly caused by?
enterovirus (eg coxackieA and B) virus enters into the heart
