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YR6: CARDIAC > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

(49 cards)

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1
Q

What is infective endocarditis?

A

Infection of the endocardium (inner lining of heart, mainly valves)

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2
Q

List 5 cardiac risk factors for infective endocarditis

A

Acquired valvular disease: rheumatic heart disease, AS, degenerative valve disease
Prosthetic heart valves
Congenital heart defects: VSD, bicuspid aortic valve
Previous endocarditis
Implantation of cardiac device

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3
Q

List 4 non-cardiac risk factors for infective endocarditis

A

IV drug use
Poor dental hygiene/ Recent dental work
IV catheter
Immunosuppression

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4
Q

List 5 causative organisms of infective endocarditis

A

Staphylococcus aureus (most common)
Streptococcus Viridans
Coagulase -ve Staph e.g. S. epidermis
Streptococcus bovis
Non-infective

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5
Q

In which patients is staphylococcus aureus IE particularly common?

A

Acute presentations
IVDU

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6
Q

What is the most common cause of IE in developing countries?

A

Streptococcus viridians: S. mitis + S. sanguinis

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7
Q

Which organisms are found in the mouth and thus linked to poor dental hygiene or following a dental procedure?

A

Streptococcus viridians: S. mitis + S. sanguinis

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8
Q

What is the most common cause of IE following prosthetic valve surgery? Why?

A

Staphylococcus epidermidis
Commonly colonize indwelling lines, usually the result of peri-operative contamination.
After 2 months the spectrum of organisms which cause endocarditis return to normal

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9
Q

Which cause of IE is associated with colorectal cancer?

A

Streptococcus bovis
Subtype S. gallolyticus is most linked with colorectal cancer

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10
Q

Name 2 non-infective causes of IE

A

SLE: Libman-Sacks
Malignancy: Marantic endocarditis

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11
Q

List 5 causes of culture negative IE

A

Prior abx therapy
Coxiella burnetii
Bartonella
Brucella
HACEK: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

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12
Q

Describe the pathogenesis of infective endocarditis

A
  1. Damaged valvular endothelium; exposure of subendothelial layer
    → adherence of platelets + fibrin
    → sterile vegetation (microthrombus)
  2. Localized infection/ contamination
    → bacteremia
    → bacterial colonization of vegetation
    → formation of fibrin clots encasing the vegetation
    → valve destruction with loss of function (valve regurgitation)
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13
Q

Describe valve involvement in IE

A

Mitral > Aortic > Tricuspid > Pulmonary

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14
Q

Which valve is most commonly affected in IVDU with IE?

A

Tricuspid

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15
Q

List 3 clinical consequences of bacterial colonisation of vegetation in IE

A

Bacterial vegetation→ bacterial thromboemboli→ vessel occlusion→ Infarctions

Emboli can lead to metastatic infections of other organs.

Formation of immune complexes + antibodies against tissue antigens → glomerulonephritis, Osler nodes

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16
Q

List 3 symptoms of infective endocarditis

A

Fever + chills (most common)
FLAWS
Arthralgias + myalgias

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17
Q

How may sub-acute IE differ in presentation to acute IE?

A

Sub-acute: nonspecific flu-like Sx
Acute: signs of acute sepsis.

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18
Q

List 3 cardiac manifestations of IE

A

New murmur
HF: due to valve insufficiency
Arrhythmias: due to perivalvular abscess causing conduction delay

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19
Q

Depending on the valve affected, which murmur may be heard in IE

A

TR: pansystolic, loudest at LSB
AR: Early diastolic loudest at 3rd ICS, LSB
MR: Pansystolic loudest at apex

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20
Q

List 4 extra-cardiac manifestations of IE

Study These Flashcards
A

Peripheral embolic + immunologic phenomena
Emboli to intra-abdominal organs
Neurological manifestations
Pulmonary manifestations

21
Q

List 4 peripheral embolic and immunologic phenomena in IE

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A

Petechiae, esp. splinter haemorrhages
Janeway lesions (non-tender macules on palms + soles)
Osler nodes (painful nodules on pads of fingers + toes)
Roth spots (retinal haemorrhages)

22
Q

Give 2 examples of where IE may emboli to intra-abdominal organs

Study These Flashcards
A

AKI: haematuria + anuria
Splenomegaly + LUQ pain

23
Q

What may cause neurological manifestations in IE?

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A

Septic embolic stroke
Hemorrhage
Meningitis
Encephalitis
Abscess

24
Q

What do pulmonary manifestations of IE result from? What does this cause?

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A

Septic emboli from tricuspid involvement
Signs of PE e.g. dyspnoea
Signs of pulmonary infection

25
What criteria is used to diagnose infective endocarditis?
Modified Duke criteria
26
What defines the Modified Duke Criteria?
Pathological criteria positive OR 2 major criteria OR 1 major + 3 minor criteria OR 5 minor criteria
27
What constitutes positive pathological criteria for IE?
+ve histology or microbiology of pathological material obtained at autopsy or cardiac surgery (valve tissue, vegetations, embolic fragments or intracardiac abscess content)
28
What are the majors in the modified duke criteria?
+ve blood cultures Evidence of endocardial involvement
29
What constitutes positive blood cultures in the major criteria for IE?
2 +ve blood cultures with typical organisms for IE OR Persistent bacteraemia from 2 blood cultures taken > 12h apart or >,3 +ve blood cultures OR +ve serology for Coxiella burnetii, Bartonella species or Chlamydia psittaci
30
What constitutes evidence of endocardial involvement in IE?
+ve echo: oscillating structures, abscess formation, new valvular regurg or dehiscence of prosthetic valves OR New valvular regurgitation
31
What are the minor criteria for IE?
Predisposing heart condition or IVDU Fever > 38ºC Vascular phenomena: major arterial emboli, splenomegaly, splinter haemorrhages, Janeway lesions Immunological phenomena: glomerulonephritis, Osler's nodes, Roth spots Microbiological evidence: +ve blood cultures not meeting major criteria or serological evidence of active infection with organism consistent with IE.
32
Describe investigations for infective endocarditis
3 separate sets of blood cultures from 3 different sites ECG TTE (possible TOE if inconclusive) Bloods: FBC, CRP, U+Es, LFTs Urinalysis
33
Why is urinalysis performed in IE? What may be found?
Septic emboli are common complication Haematuria + nephritic sediment
34
What investigation would be performed in patients with S. gallolyticus?
Colonoscopy to r/o colorectal cancer
35
What investigation should be performed in all patients with IE once stable and receiving therapy?
Dental assessment
36
What may be seen on ECG in infective endocarditis?
Progression of infection can lead conduction abnormalities Prolonged PR interval, non-specific ST/T wave abnormalities, AV block
37
What is seen on echocardiography in IE?
Valvular vegetations New valvular regurgitation +/- Abscess (e.g., perivalvular abscess)
38
List 4 poor prognostic factors in IE
S. aureus infection Prosthetic valve (esp. 'early', acquired during surgery) Culture -ve endocarditis Low complement levels
39
Describe the mortality of IE according to organism
Staphylococci - 30% Bowel organisms - 15% Streptococci - 5%
40
What is the initial blind therapy for suspected infective endocarditis in patients with a native valve?
Amoxicillin +/- low dose Gentamicin If pen allergy, MRSA or severe infection: Vancomycin + low dose Gentamicin
41
What is the initial blind therapy for suspected infective endocarditis in patients with a prosthetic valve?
Vancomycin + Rifampicin + low-dose Gentamicin
42
Tx of native valve endocarditis caused by staphylococci
Flucloxacillin If pen allergy or MRSA: Vancomycin + Rifampicin
43
Tx of prosthetic valve endocarditis caused by staphylococci
Flucloxacillin + Rifampicin + low-dose Gentamicin If pen allergy or MRSA: Vancomycin + Rifampicin + low-dose Gentamicin
44
Tx of endocarditis caused by fully-sensitive streptococci (e.g. viridans)
Benzylpenicillin If pen allergy: Vancomycin + low-dose Gentamicin
45
Tx of endocarditis caused by less sensitive streptococci
Benzylpenicillin + low-dose Gentamicin If pen allergy: Vancomycin + low-dose Gentamicin
46
When may surgical treatment be needed in infective endocarditis?
Severe valvular incompetence Aortic abscess (often indicated by a lengthening PR interval) Infections resistant to abx /fungal infections Cardiac failure refractory to standard medical Tx Recurrent emboli after abx therapy
47
List 4 complications of infective endocarditis
Acute HF Systemic embolisation inc. Stroke AKI Valvlar dehiscence, rupture or fistula
48
What is the prognosis in infective endocarditis?
FATAL if untreated 15-30% mortality even WITH treatment
49
Do dental, upper and lower GI tract, GU tract, O+G or resp procedures require IE prophylaxis?
NO

YR6: CARDIAC (41 decks)

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