Infective Endocarditis

Question 1

What is infective endocarditis (IE)?

Answer 1

Infection of the endocardium surfaces of the heart, most commonly the heart valves

Question 2

When should you suspect infective endocarditis in a patient?

Answer 2

Fever + new murmur

Question 3

What are the common causes of IE? (2)

Answer 3

Staph aureus

Strep viridans

Question 4

What are the risk factors for IE? (5)

Answer 4

IVDU (S. aureus)
Poor dental hygiene (S. viridans)
Congenital heart disease
Hx of aortic stenosis corrected w surgery and a recent hospitalisation w placement of indwelling catheter
Pseudomonas aeruginosa

Question 5

What are the clinical presentations of IE? (4)

Answer 5

Systemic: fever, night sweats, clubbing
Osler’s nodes -painful petechiae on fingertips
Janeway lesions - non-tender petechiae on hands + soles
Splinter haemorrhages (under fingernails)

Question 6

How would you diagnose IE? (2)

Answer 6

Transesophageal echo

Duke’s criteria

Question 7

Duke’s criteria. What are the minor criteria for IE? (6)

Answer 7

Fever
Echo not major
Clinical signs
Cardiac lesion
IVDU
Culture not major

Question 8

Duke’s criteria. What are the major criteria for IE? (4)

Answer 8

Positive blood culture persistently > 12hrs
2 separate positive blood cultures from different sites
Positive Echo
New valve regurgitation

Question 9

How would you treat IE? (3)

Answer 9

Penicillin 4-6w (vancomycin if staph)
Advise about good dental health
Surgery to remove large vegetations