Infective Endocarditis

Question 1

Infection of the endocardial surface of the heart w/c includes heart valves

Answer 1

Infective Endocarditis

Question 2

Infective Endarteritis

Answer 2

Analogous process involving AAV shunts, PDAs or coarctations of aorta

Question 3

Nonbacterial thrombotic endocarditis (NBTE)

Answer 3

endothelial injury —> uninfected platelet-fibrin thrombus

Question 4

Marantic endocarditis

Answer 4

hypercoagulable state —> endothelial injury

Question 5

Acute Bacterial IE

Answer 5

S. aureus
B. hemolytic sstreptococci
Pneumococci
Aerobic gram (-) bacilli

HIGH grade fever
acute/decompensated heart failure

POOR prognosis

Question 6

Subacute bacterial IE

Answer 6

S. aureus (sometimes)
Streptococcus viridans
Enterococci
HACEK
Coagulase (-) staphylococcus (prosthetic valves)

LOW grade fever
weight loss, abdominal symptoms, pleurisy

BETTER prognosis

Question 7

Cardiac manifestation of IE

Answer 7

murmur
gallop
arrhythmias
pericardial rub

Question 8

Janeway lesions

Answer 8

Non-tender, slightly raised hemorrhages on the PALMS and SOLES

Question 9

Osler nodes

Answer 9

tender, raised nodules on the PADS of FINGERS and TOES

Question 10

Splinter hemorrrhages

Answer 10

painless dark, red, linear lesions in the proximal nail bed

Question 11

Roth spots

Answer 11

retinal hemorrhages w/ small, clear centera

Question 12

MC complication of IE and indicative of surgery

Answer 12

Heart Failure

left sided regurgitation lesions such as severe aortic regurgitation

Question 13

Minor emboli

Answer 13

splinter hemorrhages
Janeway lesions
conjunctival hemorrhages

Question 14

Major emboli

Answer 14

arterial emboli
intracranial hemorrhage
pulmonary infarcts
mycotic aneurysms

Question 15

MC site of embolism

Answer 15

brain

spleen

Question 16

Other complications of IE

Answer 16

arrhythmias
glomerulonephritis - immune complex deposition at the GBM
mycotic aneurysms - focal dilations in the artery wall that have weakened by infection or septic emboli

Question 17

Duke`s criteria

Answer 17

3 2-bottle sets separated from one another by at least 1 hr and obtained from 3 diff sites over 24 hrs

DEFINITE diagnosis - 2 major OR
1 major and 3 minor OR
5 minor

POSSIBLE diagnosis - 1 major and 1 minor OR
3 minor

Question 18

Major Criteria

Answer 18

POSITIVE BLOOD CULTURE

• S. viridans
• HACEK
• S. gallolyticus
• S. aureus
• Enterococcus

OR

-persistently positive defined as recovery of a microorganism consistent w/ IE

OR

-single positive blood culture for Coxiella burnetti or phase 1 IgG antibody titer of > 1:800

EVIDENCE OF ENDOCARDIAL INVOLVEMENT

positive echocardiogram for IE

• oscillating intracardiac mass on valves or supporting structures
• abscess
• new dehiscence of prosthetic valve
• new valvular regurgitation

Question 19

Minor Criteria

Answer 19

predisposing heart condition or injection drug use

fever

VASCULAR - major arterial emboli, septic pulmonary infarcts, mycotic aneurysms, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesion

IMMUNOLOGIC - glomerulonephritis, Oslers nodes, Roths spots, RF

MICROBIOLOGIC EVIDENCE - positive blood culture but not meeting major criterion or serologic evidence of active infection w/ organism consistent w/ IE

Question 20

Done as soon as possible in all suspected IE patients

Answer 20

transthoracic echocardiogram (TTE)

Question 21

Done if w/ poor windows on TTE (obese, COPD), if initial test is non diagnostic but w/ high suspicion for IE or when considering complicated IE(abscess, prosthetic valve IE)

Answer 21

transesophageal echocardiogram (TEE)