Infective Endocarditis

Question 1

What are the causes of infective endocarditis?

Answer 1

• Strep viridian’s (20%)
• Staph aureus (most common)
• Staph epidermidis

Question 2

What is the most common cause of infective endocarditis now? Common in what presentations?

Answer 2

• Staph aureus

* Acute presentation and IVDUs

Question 3

What is the most common cause of infective endocartidis follow prosthetic valve surgery?

Answer 3

• Staph epidermidis

* As they colonise indwelling lines

Question 4

What is the most common cause of infective endocarditis in individuals with poor dental hygiene?

Answer 4

*Strep viridins

Question 5

What are the risk factors for developing infective endocarditis?

Answer 5

• Previous infective endocarditis
• Rheumatic valve disease
• Prosthetic valves
• Congenital heart defects
• IVDU

Question 6

What is the most commonly affected valve in infective endocarditis?

Answer 6

Mitral valve

Question 7

What are the signs of infective endocarditis?

Answer 7

• Pyrexia
• Murmur
• Petechiae
• Janeway lesions
• Oslers nodes
• Splinter haemorrhages
• arthritis -asymmetric within up to 3 joints

Question 8

What is the modified duke criteria for a diagnosis of infective endocarditis?

Answer 8

• Pathological criteria positive
• 2 major criteria
• 1 major + 3 minor
• 5 minor

Question 9

What is the pathological criteria for a diagnosis of infective endocarditis?

Answer 9

*Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery

Question 10

What is the major criteria for a diagnosis of infective endocarditis?

Answer 10

• Positive blood cultures

* Evidence of endocardial involvement: positive echo or new valvular regurgitation

Question 11

What is the minor criteria for a diagnosis of infective endocarditis?

Answer 11

• Predisposing hear condition or IVDU
• Fever >38
• Vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, laneway lesions, petechiae or purport
• Immunological phenomena: glomerulonephritis, oslers nodes, roth spots

Question 12

What is the management of infective endocarditis?

Answer 12

• IV antibiotics -depend on cause and culture results
• Blind abx therapy can be amoxicillin, vancomycin, gentamicin different combos
• Surgery

Question 13

When is surgery indicate in infective endocarditis?

Answer 13

• Severe valvular incompetence
• Aortic abscess
• Infections resistant to antibiotics/fungal infections
• Cardiac failure refractory to standard medial treatment
• Recurrent emboli after antibiotic therapy