Infective Endocarditis Flashcards
Causative organisms of infective endocarditis
Streptococci
Staphylococci
Enterococci
Other organisms (HACEK, negative culture)
Abnormal valves (congenital/post-rheumatic/calcification/degeneration)
Streptococci
Prosthetic heart valves
IV drug use
Staphylococci
Infective endocarditis risk factors
Abnormal valves Prosthetic valves IV drug use Turbulent flow Recent dental work
Strep infective endocarditis
a-haemolytic viridans/bovis (may be GI malignancy)
Staph infective endocarditis
Aureus
Epidermidis (IV drug use)
Enterococci infective endocarditis
E. faecalis
HACEK
Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella
Symptoms of infective endocarditis
Fever w/ sweats/chills/rigors
Malaise, arthralgia, myalgia, confusion
Signs of infective endocarditis
Pyrexia, tachycardia, signs of anaemia Clubbing New murmur (mitral > aortic > tricuspid > pulmonary) Splenomegaly Vasculitic lesions
FROM JANE (with love)
Mnemonic for signs of infective endocarditis
- fever
- roth spots
- osler nodes
- murmur (new)
- janeway lesions
- anaemia
- nail-bed haemorrhage
- emboli
Painless palmar macules
Janeway lesions
Petechiae, particularly on retinae
Roth spots
Tender nodules on finger/toe pads
Osler nodes
Nail-bed haemorrhages
Splinter haemorrhages
Prosthetic valve Dental procedure New onset murmur Vegetation on echo Right heart Indwelling catheter
Buzzwords for infective endocarditis
Infective endocarditis investigations
Bloods
3 blood cultures, 1 hr apart within 24 hrs
Urgent echo
Duke’s (Modified-Duke’s) classification
Broad-spectrum ABx until sensitivity reported
Infective endocarditis blood tests
FBC (high neutrophils, normocytic anaemia)
ESR & CRP
U&Es
Rheumatoid factor positive (if caused by rheumatic fever)
Duke’s classification major criteria
Culture findings
- typical organism from 2 cultures
- positive cultures >12 hrs apart
- ≥3 positive cultures over more than 1 hour
Echo findings
- vegetations
- new valvular regurgitation
Duke’s classification minor criteria
- predisposing cardiac/valvular abnormality
- IV drug use
- fever >38
- vasculitic phenomenon
- embolic phenomenon
- cultures positive but not matching major criteria
- echo findings but not matching major criteria
Management of suspected infective endocarditis
Supportive + empirical ABx (benzylpenicillin)
- surgery (if acutely unwell + decompensated heart failure)
Management of native valve infective endocarditis
Strep viridans - benzylpenicillin + gentamicin
Staph aureus - flucloxacillin
Management of prosthetic valve infective endocarditis
Staph - flucloxacillin/vancomycin (depending on resistance) + rifampicin + gentamicin
If resistant or penicillin allergic
Replace penicillin with vancomycin
