(!) Infective endocarditis Flashcards
Define Infective Endocarditis
Infection of the endocardium layer of the heart (innermost)-inculding valvular surfaces, chordae tendinae, septal defects and mural endocardium
Most of the time due to bacteria
staph aureus in IVDU
staph epidermis in <2 m post valve replace
Staph viridans from teeth
Tricuspid valve most common affected
can be acute-days to weeks
Or subacute-weeks to months
Signs and Sx of Infective Endocarditis
Any form of bacterimia + loud murmur/new murmur-think IE
DUKES CRITERIAS
In general-signs of infections-Fevers, headaches, chills, malaise
Acute IE often present with signs of emboli (peripheral or central)-headache, meningeal signs, stroke signs, chest pain, SOB on exertion,
arthralgia/back pain-from septic emboli
Exam-often no Janeway lesion/Osler nodes because of short disease duration
the “classic” is a new/worsening heart murmur –
tricuspid valve in IVDU
Aortic Regurg in Non IVDU
subacute-vague signs of infection-fever, aethlarhia, headache, weight loss
and a Hx of few weeks to months
Examination-janeway, oslers, splinter heammorghage
Investigations of Infective Endocarditis
DUKES CRITERIA- want 2 cultures and an echo fast
FBC-tend to be normal-occasional leukocytosis
U&E-raised urea
Urine-sceptic emboli are common-RBC, WBC, Protein
Blood culture-bacteraemia
ECG-prolonged PR, non specific weird ST, AV block
echocardiogram-transthoracic or trans oesophageal- see vegetation
Management of Infective Endocarditis
ABCDE approach and ensure blood cultures BEFORE ABx
Broad spectrum Abx - Amox and gent initially
Natural valves-tend to be strep viridans-usually just penicillin resistant
Staph aureus-MRSA-need vancomycin
Prosthetic valves-same
Might need surgery if the valve damage is to great
severe valvular incompetence
aortic abscess (often indicated by a lengthening PR interval)
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy
Complications of Infective Endocarditis
valvular heart dysfunction-> congestive heart failure–greatest complication-> acute heart failure
Systemic embolisation-can send emboli nearly anywhere-65% to brain-stroke
Valvular rupture-esp with MRSA-need surgery
