Infective Endocarditis Flashcards
What is infective endo carditis?
Presence of vegetations on the valves due to microbial colonisations, these vegetations are friable and can cause emboli.
List the tendancy of vegetations in endocarditis from highest to lowest?
Infective endocarditis
NOn bacterial thrombotic endocarditis
Rheumatic heart fever
Libmann sachs endocarditis
Which condition has the highest tendency for vegetations?
Infective endocarditis
Which condition has the lowest tendency to develop vegetations?
Libmann sachs endocarditis (SLE)
Small vegetations are seen in which condition?
Rheumatic fever and NBTE
Small to medium vegetations are seen in which condition?
Libmann sachs endocarditis
Large vegetations are seen in which condition?
Infective endocarditis
In which condition vegetations can be seen near angle of closure of valves?
Rheumatic fever and NBTE
What is the location of vegetations in libmann sachs endocarditis?
Both upper and lower sides of valves
But mostly lower
What is location of vegetations in infective endocarditis?
Both upper and lower sides of the valves
But mostly upper
Verocous and warty texture is seen which conditions?
Rheumatic fever Libmann sachs (DORLANDs Vegetations)
Irregular texture is seen in which condition?
Infective endocarditis
In which all conditions do you see NBTE
Cancer
Pro-myelolytic leukaemia
High estrogenic states
Firm vegetations are seen in which condition?
Rheumatic heart fever
Libmann sachs endocarditis
Destruction of valves occurs in which conditions?
Libmann sachs endocarditis
Infective endocarditis
Most friable vegetations are seen in which condition?
Infective endocarditis
Which all conditions have sterile vegetations?
Rheumatic heart fever
NBTE
Libmann sachs
Emboli due to vegetations occurs in which conditions?
NBTE
Infective endocarditis
Most common valves affected in libmann sachs endocarditis are?
Tricuspid and mitral valves
Most common affected valves in NBTE?
Mitral valve
Aortic and tricuspid are less often
Most common affected valves in rheumatic heart fever?
Mitral and aortic valves
Most common organism to cause infective endocarditis?
Staph aureus
Least common organism to cause infective endocarditis?
Salmonella typhi
List all organisms that cause infective endocarditis?
Staph aureus Strep. Viridans Strep. Epidermidis Pseudomonas Enterococci Salmonella typhi HACEK GROUP
Name organism in HACEK GROUP
Hemophillus Agragatibacter Cardiobacterium Ekinella Kingella
Name a condition that is caused by staph aureus, is highly virulent and occurs in native valve?
Acute infective endocarditis
Name a condition that occurs due to streptococci, low virulent and occurs mostly in previously affected valves?
Subacute infective endocarditis
Give etiology of infective endocarditis of IV drug abusers?
Candida and staph aureus
A patient is diagnosed with infective endocarditis and history tells you that he got prosthetic valves 8 months prior to consult. What is the organism.
Strep. Epidermidis(<12 months of prosthetic valve replacement)
A patient is diagnosed with infective endocarditis and history tells you that he got prosthetic valves 2 years prior to consult. What is the organism.
Strep Viridans(>12 months of prosthetic valve replacement)
Absence of murmurs occurs in which type of infective endocarditis?
Infective endocarditis of IV drug abuse
Most common etiology of Hospital acquired I.E?
Staph aureus
Most common etiology of community acquired I.E?
Streptococci
Most common etiology in I.E with abcess formation
Staph. Aureus
Most common etiology of prosthetic valve endocarditis?
Strep. Epidermidis
Which organism causes Austrian syndrome
Strep pneumoniae
What is triad of Austrian syndrome?
Oslers triad
- meningitis
- I.E
- pneumonia
Name all the high risk lesions for I.E
MR AS AR Coarctation of aorta Tetralogy of fallot PDA VSD
Name the low risk lesion for I.E
ASD
Mitral valve prolapse without MR
Name the moderate risk lesion for I.E?
PS
MS
TS
Mitral valve prolapse with MR
List the symptoms of I.E?
- chills, malaise, anorexia, weight loss, back pain,
- High grade fever , splenomegaly, digital infarction, emobism
- Janeway lesions(painless)
- Roth spots
- Oslers nodes(painful)
- Murmurs
What are the lab test results for I.E?
Anemia Leukocytosis Rheumatoid factors + 2/3 cultures positive (all done 1 hour apart) ESR & CRP elevated
Which diagnostic criteria is used for I.E?
Dukes criteria
List major criterias of Duke’s criteria?
2/3 cultures positive
Involvement of valvular lesions
List minor criteria of Duke’s
Fever
Predisposing cardiac lesions
Positive blood culture (but not meeting major criteria)
VASCULAR phenomenon (janeway lesion, pulmonary infarct,mycotic aneurysm, intracranial haemorrhage)
IMMUNOLOGICAL henomenon( oslers nodes,roth spots,glomerulonephritis)
Confirmed diagnosis of I.E if
2 major
1 major + 3 minor
5 minor
What are valvular complications of I.E
Valvular insufficiency
Valvular stenosis
Valvular perforations
What are the mural complications of IE
Abcess formation
Pericarditis(due to abcess spread)
What is complications associated with aorta in IE?
Perforations of aorta
In case of IE in patient with prosthetic valves. Which procedure is necessary?
Tracheoesophageal cardiography
Pencillin susceptible streptococci treatment?
- Penicillin G/ ceftriaxone / vancomycin-for 4 weeks
2. Gentamicin for 2 weeks
Relatively Penicillin resistant streptococci treatment?
- Penicillin G/ ceftriaxone for 4 weeks.
- Gentamicin for 2 weeks.
- vancomycin for 4 weeks.
Organism Moderate resistant to penicillin treatment ?
- Penicillin G/ceftriaxone for 6 weeks
- Gentamicin for 6 weeks
- Vancomycin for 4 weeks
Treatment for enterococci
Penicillin/ampicillin/vancomycin
Gentamicin
(BOTH FOR 4 TO 6 WEEKS)
Treatment for MSSA(methicillin susceptible staph aureus)
- Nafcillin/oxacillin/flucoxacillin
2. Cefazolin/vancomycin
Treatment for MRSA infecting native valves
Vancomycin
Treatment for MRSA infecting prosthetic valves
Vancomycin
Gentamicin
Rifampicin
Treatment for MSSA infecting Prosthetic valves?
Nifacilin/oxacillin/flucoxacillin(6-8 weeks)
Gentamycin(2 weeks)
HACEK group treatment?
Ceftriaxone 2g/day IV
Or give ampicillin or sublactam
All for 4 weeks
Doxycycline can be given for which organism
Coxella burmetti and bartonella species.
For batonella species what treatment is given
Doxycycline/ampicillin/ceftriaxone
Gentamicin
For coxiella burmetti what is the treatment?
Doxycycline
Indication for surgical treatment in IE?
Aortic valve endocarditis Prosthetic valve endocarditis Fungal endocarditis Presence of valve ring abscess Failiure of medical treatment Very large vegetations that can cause emboli
What is the etiology of fungal endocarditis
Candida and aspergillosis
Medical and surgical treatment for fungal endocarditis?
Medical- Amphotericin B & Flucytosine
Surgical - Radical surgical debridement
Most commonly affect population with fungal endocarditis
People with prosthetic valves or immune compromised
A Patient with prosthetic valve and infective endocarditis is undergoing another surgery. What prophylaxis drug will you suggest.
Amoxicillin
Clindamycin/cefalexin/clarithromycin (if allergic to amoxicillin)
Gentamycin(if gram -ve organism)
Cardiac high ridk lesions where amoxicillin prophylaxis is requir
Prosthetic valves endocarditis Prior bacterial endocarditis Cyanotic congenital heart disease PDA Coarctation of aorta
Cardiac moderate risk lesions where amoxicillin prophylaxis is required?
Hypertrophic cardiomyopathy MR AR Bicuspid aortic valve VSD Mitral valve prolapse
Low risk cardiac lesions where amoxicillin prophylaxis is required
Presence of cardiac pacemaker, fibrillators
CABG
ASD
Physiological and functional murmurs