Infective Endocarditis Flashcards
What is IE
Infection of the endocardium
Which layer of the heart is the endocardium
Inner most layer of the heart
Risk factors
IV drug abuse Rheumatic heart disease Dental Rx DM Cardiac lesson Prosthetic valves Congenital heart disease Mitral regurgitate Aortic regurgitate
Main organism causes
Strep Viridens
Staph Aureus
Strep Bovis
Enterococci
Rarer causes organisms
HACEK organisms
What should you suspect in anyone presenting with a fever and a new cardiac murmur
IE
Clinical signs of IE
Janeway lesions Splinter haemorrhages Oslers nodes Roth spots New murmur Fever Vasculitis rash
Main Ix for IE
3 blood cultures
3 different ties >6hrs apart
3 different sites
Other Ix for IE
FBC CRP ESR U&Es ECG CXR ECHO
2 types of ECHO
Transoesophageal
Transthoracic
What are the major criteria for Dukes classification
- 2 separate +ve blood cultures
2. Evidence of endocardium involvement
What are the minor criteria for Dukes Classification
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
What combination of major and minor Dukes is needed for definite Dx of IE
2 Major
1 Major + 3 Minor
5 Minor
What combination of major and minor Dukes is needed for possible Dx of IE
1 Major
3 Minor
Rx for native valve IE
IV Amoxicillin and IV Gentamicin
When would Rx be IV Gentamicin and IV Vancomycin
Penicillin allergic (so can’t amoxicillin)
Sever sepsis
MRSA detected
What is the Rx for IE in prosthetic valve disease
IV Gentamicin, IV Vancomycin + IV Rifampicin
What should you notes about Gentamicin
It is nephrotoxic
So keep an eye on this
Examples of Bacterial source in IE
Infected needle (IV drug abuse) Open wound Dental procedure Cardiac device Surgery Intravascular catheter
Examples of abnormal substrate in IE
Prosthetic valve Native valve damage Rheumatic heart disease MV prolapse AV disease Congenital heart disease
Which side of the heart does IE mainly affect in drug abusers
Right side
Which side of the heart does IE typically affect in native or prosthetic valves
Left side
