Infective Endocarditis Flashcards
When should a presentation be considered infective endocarditis until proven otherwise?
Fever and new murmur
What’s the difference between acute and subacute infective endocarditis?
Acute - occurs on normal valves - presents with acute heart failure and emboli - S.aureus Subacute - occurs on abnormal valves - S.epididymis (prosthetic valves)
What are the risk factors for acute infective endocarditis?
Skin breaches - dermatitis, IV lines, wounds
Renal failure
Immunosuppression
Diabetes mellitus
What are the risk factors for subacute infective endocarditis?
Aortic/mitral valave disease IVDU - tricuspid valves Coarction Patent ductus arteriosum Prosthetic valves Ventricular septal defect
What are the bacterial causes of infective endocarditis?
S.viridans - most common (subacute) found in the mouth
S.aureus
S.bovis - associated with colon carcinoma
Enterococci
Coxcella bumetti - infected animals
HACEK - gram negative
What are the fungal causes of infective endocarditis?
Candida, aspergillus and histoplasma
Usually in IVDU, immunocompromised or prosthetic valves
High mortality
What are the signs and symptoms of acute infective endocarditis?
Fever and new murmur Petechiae - red/purple, non-blanching spots Cardiac and renal failure Rigors Night sweats Immune complex depositions - Osler's nodes - Nail fold infarcts Embolic incidents - cerebral - Janeway lesions and Osler's nodes - splinter haemorrhages - Roth spots - boat shaped retinal haemorrhages with pale centre Malaise Clubbing Weight loss
What are the signs and symptoms of subacute infective endocarditis?
Known congenital valve disease + and of the s/s of acute infective endocarditis
Unknown murmurs
Splenomeagly - especially coxiella burnetti
Purpura
Osler’s nodes
How is infective endocarditis diagnosed?
Modified Duke's criteria - 2 major OR - 1 major and three minor OR - 5 minor Blood cultures Bloods - normochromic, normocytic anaemia - increased ESR - neutrophila - positive rheumatoid factor - U&Es, magnesium and LFTs Urinalysis CXR - cardiomeagly and pulmonary oedema ECGs Echo - TOE best CT - emboli
What are the major criteria in the modified Duke’s criteria?
Blood cultures (ONE OF)
- positive blood cultures in two separate cultures
- persistently positive cultures for 3-12 hours
- single positive for coxiella burnetti
Endocardium involved (ONE OF)
- positive echo (vegetation, abscess, pseudoaneurysm)
- abnormal prosthetic valve on PET/CT
- paravalvular lesions on cardiac CT
What are the minor criteria in the modified Duke’s criteria?
Predisposition - cardiac lesion, IVDU
Fever >38 degrees
Vascular phenomena
- emboli, Janeway lesions, aneurysms, nail-fold infarcts
Immunological phenomena
- Roth spots, Osler’s nodes, GN, renal failure
Positive cultures not meeting major criteria
Unusual echo not meeting major criteria
What are the two ways you can treat infective endocarditis?
Antibiotics
Surgery
Which antibiotics are indicated in infective endocarditis?
Native valve
- ampicillin, flucloxacillin and gentamicin
Prosthetic valve
- vancomycin, gentamicin and rifampicin
Specific infections
- native valve staph - flucloxacillin
- prosthetic valve staph - flucloxacillin, rifampicin and gentamicin
- strep - benpen (+gentamicin if required)
- enterococci - amoxicillin and gentamicin
- HACEK - ceftrioxone
What anti-fungals are required in the case of a fungal infection?
Candida - amphoterecin
Aspergillus - voriconazole
When is surgery indicated in infective endocarditis?
Heart failure Valvular obstruction Repeated emboli Fungal infective endocarditis Persistent bacteraemia Myocardial abscess Unstable infected prosthetic valve
