Infective Endocarditis

Question 1

What is infective endocarditis?

Answer 1

Infection of the valves

Question 2

What is the classical history of infective endocarditis?

Answer 2

• Fever
• Anorexia, weight loss
• Rigors, night sweats
• Shortness of breath
• Chest pain
• Embolic complications

Enquire about dental history and risk factors:

• Heart disease
• Valve implants
• IVDU

Question 3

What are the examination and investigations performed for infective endocarditis?

Answer 3

Examinations:

• New heart murmurs that change
• Clubbing
• Splinter haemorrhages
• Janeway lesions
• Osler’s nodes
• Roth spots

Investigations:

• Urinalysis
• FBC, U&Es, CRP, ESR
• 3x blood cultures
• TOE
• Serology and CXR

Question 4

What organisms cause infective endocarditis?

Answer 4

Acute
- Coagulase negative staphylococci (prosthetic valve)

Subacute
- Strep viridans

IVDU: staph aureus

Question 5

What is the treatment for infective endocarditis?

Answer 5

Empirical:
- Vancomycin + gentamicin + rifampicin

Strep viridans:
- BenPen + gentamicin

MSSA:
- Flucloxacillin

MRSA: vancomycin +gent/rifampicin/fucidin

Question 6

What valves are commonly involved in infective endocarditis?

Answer 6

Mitral and aortic

IVDU: tricuspid

Question 7

What are the indications for surgical intervention in infective endocarditis?

Answer 7

• > 1 serious embolus
• Uncontrolled infection
• Valve dysfunction
• No response to antibiotics
• Abscess