Infective Endocarditis

Question 1

Infective Endocarditis

Answer 1

Infection of inner layer of heart, including cardiac valves

Improved prognosis with Abx therapy

Question 2

Subacute form

Answer 2

Preexisting valve disease

Longer clinical course – takes a while for patients to seek treatment

Question 3

Acute form

Answer 3

Healthy form
Rapidly progressive
Common in IV drug users, bacteria moves through veins and sits in heart
*mitral valve drug abuse IE

Question 4

Causative Organisms

Answer 4

Bacterial = most common
Staph viridans
Staph aureus
Viruses
Fungi

Question 5

Etiology and Patho

Answer 5

Occurs when blood flow within the heart allows causative organism to infect previously damaged valves or other endothelial surfaces
Bacteria clings to valve and inflammatory process mounts attack, clings to bacteria 🡪 vegetation 🡪 valve can’t open/close as it should due to build-up on valve
Vegetation
Fibrin, leukocytes, platelets and microbes
Adheres to the valve or endocardium
Parts break off and enter circulation (septic embolization)

Question 6

Risk Factors

Answer 6

Cardiac – valve disease, mitral valve prolapse, mitral valve replacement; non-cardiac, procedural

Increased age
IV drug abuse (IVDA)
Prosthetic valves
Use of intravascular devices
Renal dialysis

Question 7

Clinical Manifestations

Answer 7

Nonspecific in beginning
Flulike symptoms: 
Fever
Chills
Weakness
Malaise
Fatigue
Anorexia 
Think about what risk factors they have

Question 8

Subacute form Manifestations

Answer 8

Arthralgias
Myalgias
Back pain
Abdominal discomfort
Weight loss
Headache
Finger clubbing

Question 9

Vascular manifestations

Answer 9

Splinter hemorrhages (black lines) in nailbeds (microemboli)
Petechiae
Oslers nodes on fingertips or toes = painful red dots, usually fingerpads/toes
Janeway’s lesions (painless) on pads of the fingers and toes
Roth’s spots = microemboli in eyes

Question 10

Prophylactic (PO) Abx

Answer 10

reatment for select patients (prior endocarditis, Hx valve disease) having
Certain dental procedures
Respiratory tract incisions
Tonsillectomy and adenoidectomy
Surgical procedures involving infected sin, skin structures, or musculoskeletal tissue

Question 11

Diagnostics

Answer 11

History (age, previous cardiac disease, IVDA, previous dental/gyn surgery)
Lab tests
Blood cultures
CBC with diff (WBC)
ESR, C-reactive protein (CRP) (elevated, inflame markers)
Echocardiography: shows vegetation, if valves are working
Chest x-ray: may reveal enlarged heart
ECG (dysrhythmias r/t infection)
Heart catheterization