Infective Endocarditis Flashcards
What is infective endocarditis?
Infection of the endothelium of the heart, heart valves, intraventricular septum, chord tendinae and intra-cardiac devices.
What is the most commonly affected heart valve in infective endocarditis?
Mitral valve
Why are heart valves commonly affected in infective endocarditis?
Due to limited blood supply, thus lack of wbc.
Circulating bacteria adhere to the valve causing vegetation
RF for endocarditis? (12 (split into cardiac and non-cardiac RF))
Cardiac: Rheumatic heart disease, Aortic stenosis, Aortic/ mitral regurgitation, Congenital heart disease, Prosthetic heart valve
Non-Cardiac: IV drug abuse, AIDS, Diabetes, Solid organ transplant, Chronic skin infection, Burns, Alcoholic cirrhosis
Causative agents of endocarditis? (8)
Strep viridians,
staph aureus,
staph epidermis
HACEK- haemophillus, actinobacillus, cardiobacterium, eikenella, kingella
What classification criteria is used for infective endocarditis?
Dukes
Criteria needed to be classed as having infective endocarditis?
(split into major and minor (FIVE), certain number of each needed to be classed)
2 major OR
5 minor OR
1 major + 3 minors
Major:
- 2 seperate +ve blood cultures
- Endocardial involvement
Minor:
- Fever
- IV drug user or predisposing heart condition
- Immunological phenomenom (Roths spots, oslers nodes)
- Vascular phenomenon (Janeway lesions, mycotic aneurysm)
- Echocardiogram findings
Investigations for endocarditis? (5)
Blood cultures- 3 cultures from 3 sites, Bloods- FBC Urinalysis, CXR, ECHO (transoesophageal, transthoracic)
Signs for infective endocarditis? (8) (FROM JANE)
Fever
Roths spots
Oslers nodes
Murmur (new)
Janeway lesions
Anaemia
Nail (splinter haemorrhages)
Emboli
Treatment for endocarditis? (depends on type of causative agent and type of heart valve)
Medical- antibiotics
for strep/ staph- IV gentamicin and IV amoxicillin for 4 weeks
for aspergillus- miconazole
For prosthetic valve- gentamicin, IV vancomycin for 6 weeks
Surgical- valve replacement
Complications of infective endocarditis? (6)
Heart failure, arrhythmia, emboli formation, abscess formation, fistula formation, leaflet perforation
Symptoms of infective endocarditis? (5)
Fever, fatigue, malaise, weight loss, headache
what are Roth spots?
retinal haemorrhage
What are Osler’s nodes?
deep, red spots,
painful,
fingers/ palms/ soles
What are Janeway lesions?
flat, macular, non tender echymotic lesions on palms/soles
