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Paediatrics > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

What is infective endocarditis?

A
  • it is a infectious inflammation of the endocardium that affects the heart valves
  • it is as a result of bacteria lodging on the heart valves from dental procedures, surgery, primary infections, and non-sterile injections
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2
Q

What bacteria causes the acute disease?

A

Staphylococcus aureus and this causes rapid valve destruction

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3
Q

What bacteria causes sub-acute disease?

A

Streptococci viridans and this is as a result. Of prosthetic valves, previously damaged valves and heart defects

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4
Q

How long does it take for staphylococcus to kill you?

A

6 weeks if left untreated

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5
Q

What is the etiology of IE?

A
  1. Staphylococcus aureus (most common with 45-65%)
  2. Streptococci viridans (mostly 30% and on already damaged valves)
    - most from dental procedures
  3. Gram (-) HACEK group
  4. Enterococci
  5. Candida aspergillus (immune-compromised patients and IV drug users)
  6. Staphylococcus epidermis (multiple drug resistance)
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6
Q

Which groups of people are usually affected by staph aureus?

A
  • previously healthy valves
  • IV drug users
  • people with prsothetic valves
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7
Q

What does the HÁČEK group stand for?

A 
H- Haemophillus 
A-Aggregatebacter
C-Cardiobacterium 
E-Eikenella 
K-Kingella
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8
Q

What are the predisposing factors that lead to the increased chance of IE?

A
  1. Damaged heart valves
  2. Prosthetic heart valves
  3. Congenital heart defects
  4. Diabetic children
  5. Previous IE
  6. Children on corticosteroids
  7. Rheumatic Heart Disease
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9
Q

Which valves are most affected by IE?

A

First are mitral valves, second being aortic valves then tricuspid and last being pulmonic valves

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10
Q

Which valve is affected most by IV drug users?

A

Tricuspid valve

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11
Q

What are the constitutional symptoms of IE?

A
  1. Fever and chills in 90% of people
  2. Tachycardia
  3. Myalgia, arthralgia
  4. General malaise
  5. Night sweats, weight loss
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12
Q

What are the extra-cardiac manifestations of IE?

A
  1. Janeway lesions
  2. Roth spots in the eye
  3. Osler Nodes
  4. Petechiae
  5. Clubbing
  6. Splenomegaly
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13
Q

What are the cardiac manifestations for IE.

A
  1. Murmurs
    Mitral valve regurgitation - holosystolic murmur radiating to the left axilla
    Tricuspid valve regurgitation - holosystolic murmur occurring in IV drug users, HIV positive
    Aortic regurgitation- early-diastolic murmur
  2. Dyspnea
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14
Q

What are the special investigations we do in these patients?

A
  1. 3 blood cultures in 3 hours
  2. FBC
  3. ESR and CRP
  4. Urinalysis
  5. U&E
  6. Echocardiogram (Transthoracic echocardiogram)
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15
Q

What is the Duke criteria?

A

It is the modified criteria that is used to diagnose infective endocarditis

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16
Q

What makes a definitive diagnosis?

A

-2 major criteria or 1 major with 3 minor criteria

17
Q

What makes a possible IE diagnosis?

A

1 major and 1 minor OR 3 minor criteria

18
Q

What are the major criteria?

A
  1. > 2 positive blood cultures with pathogens
  2. New valvular manifestations
  3. Positive findings on echocardiography
19
Q

What are the minor criteria for IE?

A
  1. Immunological phenomenon
  2. Vascular phenomenon-petechiae, purpura
  3. Pre-disposing factors
  4. Fever> 38 degrees
  5. Positive blood culture inflammatory markers
20
Q

What is the management of IE?

A

We give antibiotics for a maximum of 6 days
For streptococci viridans- penicillin and gentamicin/amikacin
For staphylococcus aureus we give cloxacillin or gentamicin/amikacin
If severe you can surgically replace valves

21
Q

What are some of the preventative measures we can implement?

A
  • antibiotic cover during procedures
  • change IV lines regularly
  • remove in dwelling catheters regularly
22
Q

What clinical signs do we look for Infective Endocarditis?

A
  1. Ossler nodes
  2. Janeway lesions
  3. Digital clubbing
  4. Splinter Haemorrhages

Paediatrics (40 decks)

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