Infective Endocarditis

Question 1

Define Infective Endocarditis:

Answer 1

Inflammation of the endocardium - inner surface of the heart including the valves.

Question 2

Infective Endocarditis: Organisms:
1.
2.

Answer 2

Infective Endocarditis: Organisms:

1. Staphylococcus Aureus (IV Drug Users)
2. Streptococcus Viridans

Question 3

In IV Users with Infective Endocarditis:
What is the most likely causative agent?
What valve is most likely affected?

Answer 3

In IV Users with Infective Endocarditis:
Causative agent: Staphylococcus Aureus
Valve affected: Tricuspid

Question 4

Key Presenting Feature in Infective Endocarditis?
F
NM

Answer 4

Key Presenting Feature in Infective Endocarditis?
Fever
New Murmur

Question 5

Infective Endocarditis: Risk Factors:
PIE
IVDU
RVD

Answer 5

Infective Endocarditis: Risk Factors:
Previous Infective Endocarditis
IVDU: IV Drug Users
Rheumatic Valve Disease

Question 6

Infective Endocarditis: Complications: 
S
RF
CHF
VR
V (SE)

Answer 6

Infective Endocarditis: Complications: 
Stroke
Renal Failure
Chronic Heart Failure
Valve Regurgitation
Vegetations (Systemic Emboli)

Question 7

Infective Endocarditis: Mortality:
Staphylococcus:
Bowel Organisms:
Sensitive Streptococci:

Answer 7

Infective Endocarditis: Mortality:
Staphylococcus: 30%
Bowel Organisms: 14%
Sensitive Streptococci: 6%

Question 8

Infective Endocarditis: Symptoms/Signs:
JOR
FFANNSS
MMWV

Answer 8

Infective Endocarditis: Symptoms/Signs:
Janeway Lesions, Osler’s Nodes. Roth Spots

Fever, Finger clubbing, Aanaemia, New murmur, Night Sweats, Splinter Hemorrhages, Spleenomegaly

Malaise, MSK Pain, Weight Loss, Vasculitis.

Question 9

Infective Endocarditis: Investigations: 
B
Duke Criteria: 
C
E
E
U
While awaiting Bloods: TE = 1st Line

Answer 9

Infective Endocarditis: Investigations:
Bloods: 3 sets (6 bottles) over 24 hrs, at peak of fever - micro diagnosis.
Duke Criteria:
Chest X Ray - Cardiomegaly
ECG - Long PR Interval - check at regular intervals
Echocardiogram - vegetations - transthoracic echo
Urinalysis - microscopic haematuria
While awaiting Bloods: Transthoracic Echo = 1st Line

Question 10

How is a Diagnosis made using the Duke Criteria for Infective Endocarditis:

Answer 10

Definitive Infective Endocarditis:
2 major
1 major & 3 minor
All 5 minor (if no major)

Question 11

Duke Major Criteria for Infective Endocarditis:
\+ BC 
-
-
Endocarium
-
-

Answer 11

Duke Major Criteria for Infective Endocarditis:
+ Positive Blood Culture
- Typical Organism in 2 separate cultures
- Persistently positive blood Cultures
Endocardium
- Positive Echo - vegetations, abscess, dehiscence of prosthetic valve
- New Valvular Regurgitation

Question 12

Duke Minor Criteria for Infective Endocarditis:
P
F
BC
Echo

Answer 12

Duke Minor Criteria for Infective Endocarditis:
Predisposition - cardiac lesion or IVDU
Fever > 38’C
Blood Culture Positive: but doesn’t meet major criteria
Echocardiogram that does not meet major criteria

Question 13

Infective Endocarditis: Treatment:
A: NV-A, PV-G, V, R
IV, O:
Surgery - consider indications - next card.

Answer 13

Infective Endocarditis: Treatment:
Antibiotics:
Native Valve: Amoxycillin
Prosthetic Valve: Gentamicin, Vancomycin, Rifampicin.
IV antibiotics for 2 weeks, & then Oral for 4 weeks.
Surgery - consider indications - next card.

Question 14

Infective Endocarditis: Indications for Surgery 
SVR
R
CF
RE
AA
LVeg
PP
PRF

Answer 14

Infective Endocarditis: Indications for Surgery 
Severe Valvular Regurgitation
Resistance - antibiotic/fungal
Cardiac Failure - refractory to medical treatment
Recurrent Emboli - after therapy
Aortic Abscess
Large Vegetations
Persistant Pyrexia
Progressive Renal Failure.