Infective endocarditis

Question 1

What is infective endocarditis?

Answer 1

Infectious inflammation of the endocardium that affects the heart valves

Question 2

What main organisms cause infective endocarditis?

Answer 2

Staphylococcus aureus

Viridans streptococci

Question 3

What are the causes of infective endocarditis?

Answer 3

(Preexisting conditions) Previous IE, Predamaged or prosthetic heart valves, Congenital heart defects, Chronic hemodialysis, Impaired immunity
Bacteremia

Question 4

What are the two types of infective endocarditis?

Answer 4

Acute disease: usually caused by Staphylococcus aureus and causes rapid endocardium destruction
Subacute progression: caused by viridans streptococci species and generally affects individuals with pre-existing damage to the heart valves, structural heart defects, or the presence of prosthetic valves.

Question 5

What are the clinical features of infective endocarditis?

Answer 5

Fever and chills (∼ 90% of cases), tachycardia
General malaise, weakness, night sweats, weight loss
Dyspnea, cough, pleuritic chest pain
Splinter haemorrhage, Janeway lesion, Osler node
(Heart murmurs) Mitral valve regurgitation → pansystolic murmur
Tricuspid valve regurgitation → pansystolic murmur
Aortic valve regurgitation → early diastolic murmur

Question 6

How is infective endocarditis diagnosed?

Answer 6

(Labs) Multiple blood cultures, Leukocytosis ( ↑ ESR, ↑ CRP)
(Echocardiography)
((Modified) Duke criteria) 2 major ; 1 major + 3 minor ; 5 minor
Major: Two separate blood cultures positive or endocardial involvement in echocardiography
Minor: underlying heart disease or IV drug abuse or Fever ≥ 38°C or Vascular abnormalities or Immunologic disorder or Microbiology

Question 7

What is the treatment for endocarditis?

Answer 7

Gentamicin + penicillin or vancomycin or ampicillin for 6 weeks