Infective Endocarditis

Question 1

Define infective endocarditis.

Answer 1

An infection of the endocardium or heart valves. Staphylococcus aureus followed by Streptococci of the viridans group and coagulase negative Staphylococci are the three most common organisms responsible for infective endocarditis.

Question 2

Explain the aetiology/risk factors of infective endocarditis.

Answer 2

Poor dentition/gingivitis
Prior hx of infectious endocarditis
Presence of artificial prosthetic heart valves
Certain types of congenital heart disease
Post-heart transplant (patients who develop cardiac valvulopathy)

Question 3

Summarise the epidemiology of infective endocarditis.

Answer 3

Men are affected 2.5 times more often than women, and there does not appear to be any difference among people of different ancestries.

Question 4

Recognise the presenting symptoms of infective endocarditis.

Answer 4

Chest pain
SOB
Fever
Night sweats/fatigue/malaise

Question 5

Recognise the signs of infective endocarditis on physical examination.

Answer 5

Janeway lesions
Osler nodes
Splinter haemorrhages

Question 6

Identify appropriate investigations for infective endocarditis and interpret the results.

Answer 6

ECG
Echo
Serum chemistry panel with glucose
FBC
Urinalysis
Blood cultures

Question 7

Generate a management plan for infective endocarditis.

Answer 7

Determine which antibiotics the bacteria is sensitive to and administer those antibiotics. Macrolides are usually popular (gentamicin etc.)

Surgery may be considered in severe cases.

Question 8

Identify the possible complications of infective endocarditis and its management.

Answer 8

Congestive heart failure (CHF)
Systemic embolisation
Anterior mitral valve vegetation >10 mm
Valvular dehiscence, rupture, or fistula
Splenic abscess
Mycotic aneurysms

Question 9

Summarise the prognosis for patients with infective endocarditis.

Answer 9

There are no comprehensive studies that have looked at overall prognosis in patients with IE. Congestive heart failure remains the single greatest predictor of prognosis in patients, regardless of the offending micro-organism. Surgery, if indicated, has been associated with a lower overall mortality; however, patients with definitive indications for surgery tend to be critically ill and carry a high intra-operative mortality rate.