Infective endocarditis

Question 1

What is infective endocarditis?

Answer 1

Infective endocarditis (IE) is an infection involving the endocardial surface of the heart, including the valvular structures, the chordae tendineae, sites of septal defects, or the mural endocardium.

Question 2

What are the most common bacterial causes of endocarditis?

Answer 2

Gram +ve: Strep viridans or aureus, First seen in native and aureus common in IVDU, CONS in prosthetic

Gram -ve: HACEK (rare) more common in prosthetic valves

Question 3

What is the presentation of IE?

Answer 3

Fever, new murmur.

Septic signs

embolic: petechiae, splinter haemorrhages, janeway lesions, stroke

immune complex: osler nodes, roth spots, vasculitis

Question 4

What are types of IE?

Answer 4

Acute: tends to occur in healthy native valves, and patients can present with acute HF and emboli.

Subacute: valve disease or prosthetic,

Question 5

What investigations should you do for IE?

Answer 5

Blood cultures

FBC, CRP, WCC

Echo: vegetations

CT angiogram: septic emboli

Question 6

What is Duke’s criteria?

Answer 6

Definite endocarditis if:
• 2 major
• 1 major and 3 minor
• No major and all 5 minor

Major
• Typical organism in 2 separate blood cultures
• Positive echocardiogram (vegetation, abscess) or new valve regurgitation

Minor
• Predisposition (heart condition or IVDU)
• Fever >38˚C
• Vascular phenomena (eg. septic emboli)
• Immunological phenomena (eg. oslers nodes)
• Positive blood cultures (not meet major criteria)

Question 7

What is management of IE?

Answer 7

Antibiotics

Surgery to repair or replace damaged valves and drain any abscesses