Infective Endocarditis

Question 1

Causative organisms of infective endocarditis

Answer 1

Streptococci
Staphylococci
Enterococci
Other organisms (HACEK, negative culture)

Question 2

Abnormal valves (congenital/post-rheumatic/calcification/degeneration)

Answer 2

Streptococci

Question 3

Prosthetic heart valves

IV drug use

Answer 3

Staphylococci

Question 4

Infective endocarditis risk factors

Answer 4

Abnormal valves
Prosthetic valves
IV drug use
Turbulent flow
Recent dental work

Question 5

Strep infective endocarditis

Answer 5

a-haemolytic viridans/bovis (may be GI malignancy)

Question 6

Staph infective endocarditis

Answer 6

Aureus

Epidermidis (IV drug use)

Question 7

Enterococci infective endocarditis

Answer 7

E. faecalis

Question 8

HACEK

Answer 8

Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

Question 9

Symptoms of infective endocarditis

Answer 9

Fever w/ sweats/chills/rigors

Malaise, arthralgia, myalgia, confusion

Question 10

Signs of infective endocarditis

Answer 10

Pyrexia, tachycardia, signs of anaemia
Clubbing
New murmur (mitral > aortic > tricuspid > pulmonary)
Splenomegaly
Vasculitic lesions

Question 11

FROM JANE (with love)

Answer 11

Mnemonic for signs of infective endocarditis

• fever
• roth spots
• osler nodes
• murmur (new)
• janeway lesions
• anaemia
• nail-bed haemorrhage
• emboli

Question 12

Painless palmar macules

Answer 12

Janeway lesions

Question 13

Petechiae, particularly on retinae

Answer 13

Roth spots

Question 14

Tender nodules on finger/toe pads

Answer 14

Osler nodes

Question 15

Nail-bed haemorrhages

Answer 15

Splinter haemorrhages

Question 16

Prosthetic valve
Dental procedure
New onset murmur
Vegetation on echo
Right heart
Indwelling catheter

Answer 16

Buzzwords for infective endocarditis

Question 17

Infective endocarditis investigations

Answer 17

Bloods
3 blood cultures, 1 hr apart within 24 hrs
Urgent echo
Duke’s (Modified-Duke’s) classification
Broad-spectrum ABx until sensitivity reported

Question 18

Infective endocarditis blood tests

Answer 18

FBC (high neutrophils, normocytic anaemia)
ESR & CRP
U&Es
Rheumatoid factor positive (if caused by rheumatic fever)

Question 19

Duke’s classification major criteria

Answer 19

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

Question 20

Duke’s classification minor criteria

Answer 20

• 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

Question 21

Management of suspected infective endocarditis

Answer 21

Supportive + empirical ABx (benzylpenicillin)

- surgery (if acutely unwell + decompensated heart failure)

Question 22

Management of native valve infective endocarditis

Answer 22

Strep viridans - benzylpenicillin + gentamicin

Staph aureus - flucloxacillin

Question 23

Management of prosthetic valve infective endocarditis

Answer 23

Staph - flucloxacillin/vancomycin (depending on resistance) + rifampicin + gentamicin

Question 24

If resistant or penicillin allergic

Answer 24

Replace penicillin with vancomycin