Infective Endocarditis

Question 1

What is IE

Answer 1

Infection of the endocardium

Question 2

Which layer of the heart is the endocardium

Answer 2

Inner most layer of the heart

Question 3

Risk factors

Answer 3

IV drug abuse 
Rheumatic heart disease
Dental Rx 
DM 
Cardiac lesson 
Prosthetic valves 
Congenital heart disease 
Mitral regurgitate 
Aortic regurgitate

Question 4

Main organism causes

Answer 4

Strep Viridens
Staph Aureus
Strep Bovis
Enterococci

Question 5

Rarer causes organisms

Answer 5

HACEK organisms

Question 6

What should you suspect in anyone presenting with a fever and a new cardiac murmur

Answer 6

IE

Question 7

Clinical signs of IE

Answer 7

Janeway lesions 
Splinter haemorrhages 
Oslers nodes
Roth spots
New murmur
Fever
Vasculitis rash

Question 8

Main Ix for IE

Answer 8

3 blood cultures
3 different ties >6hrs apart
3 different sites

Question 9

Other Ix for IE

Answer 9

FBC 
CRP 
ESR U&Es 
ECG 
CXR 
ECHO

Question 10

2 types of ECHO

Answer 10

Transoesophageal

Transthoracic

Question 11

What are the major criteria for Dukes classification

Answer 11

1. 2 separate +ve blood cultures

2. Evidence of endocardium involvement

Question 12

What are the minor criteria for Dukes Classification

Answer 12

Predisposition (e.g IV drug abuse)
Fever >38
Vascular phenomena (e.g Janeway lesions)
Immunological phenomena (e.g Oslers nodes, Roth)
+ve blood cultures that dont meet major criteria

Question 13

What combination of major and minor Dukes is needed for definite Dx of IE

Answer 13

2 Major
1 Major + 3 Minor
5 Minor

Question 14

What combination of major and minor Dukes is needed for possible Dx of IE

Answer 14

1 Major

3 Minor

Question 15

Rx for native valve IE

Answer 15

IV Amoxicillin and IV Gentamicin

Question 16

When would Rx be IV Gentamicin and IV Vancomycin

Answer 16

Penicillin allergic (so can’t amoxicillin)
Sever sepsis
MRSA detected

Question 17

What is the Rx for IE in prosthetic valve disease

Answer 17

IV Gentamicin, IV Vancomycin + IV Rifampicin

Question 18

What should you notes about Gentamicin

Answer 18

It is nephrotoxic

So keep an eye on this

Question 19

Examples of Bacterial source in IE

Answer 19

Infected needle (IV drug abuse)
Open wound 
Dental procedure 
Cardiac device 
Surgery 
Intravascular catheter

Question 20

Examples of abnormal substrate in IE

Answer 20

Prosthetic valve 
Native valve damage 
Rheumatic heart disease 
MV prolapse 
AV disease
Congenital heart disease

Question 21

Which side of the heart does IE mainly affect in drug abusers

Answer 21

Right side

Question 22

Which side of the heart does IE typically affect in native or prosthetic valves

Answer 22

Left side