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Cardiology > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

What is Endocarditis?

A
  • Inflammation of inner layer of heart
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2
Q

What are the two types of endocarditis?

A
  • Endocarditis on normal valves - acute IE
  • Endocarditis on abnormal valves - subacute IE
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3
Q

What are the commonest organisms to cause Infective Endocarditis?

A
  • Common in Native valve
    • Strep Viridans (50%)
    • Staph Aureus (20%)
  • IV drug user
    • Staph Aureus
  • Prosthetic valves
    • Staph epidermidis
  • enterococcal group
  • HACEK group
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4
Q

What does the HACEK gram -ve bacteria represent?

A
  • Haemophilus
  • Actinobacillus
  • Cardiobacterium
  • Eikenella
  • Kingella
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5
Q

What are the features of Strep Viridans?

A
  • Optochin resistant
  • a-haemolytic
  • catalase -
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6
Q

What are the commensals for Strep Viridans?

A
  • Teeth
  • Oropharynx
  • GI
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7
Q

What is the commonest organism to cause acute infective endocarditis?

A
  • Staph Aureus
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8
Q

How does acute IE present?

A
  • acute heart failure
  • emboli
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9
Q

What are the RF for acute IE?

A
  • Dermatitis
  • IV lines
  • Open wounds
  • Renal failure
  • DM
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10
Q

What are the RF for subacute IE?

A
  • aortic/mitral disease
  • tricuspid valves in IVD users
  • prosthetic valves
  • congenital heart defects
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11
Q

What 2 presentations will make you think of IE?

A
  • Fever
  • New murmur
  • Think IE until proven otherwise
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12
Q

What are the Sx for IE?

A
  • Septic signs
    • Fever, night sweats, weight loss, anaemia, clubbing
  • Cardiac signs
    • murmur
    • PR prolongation - if aortic root abscess present
    • LVF
  • Immune complex deposition
    • vasculitis
    • glomerulonephritis > AKI
    • splinter hemorrhage
    • janeway lesions
    • osler nodes
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13
Q

What ix would you order for IE?

*bolded are key diagnostic ix

A
  • Bedside
    • Urine dipstick analysis
    • MSU
    • ECG
  • Bloods
    • FBC
    • ESR & CRP
    • U&E
    • LFT
  • blood culture
  • Imaging
    • CXR
    • TTE - initial imaging of choice
    • TOE
      • mitral valve & prosthetic valve vegetations
      • aortic root abcess
      • septal abcess
      • leaflet perforations
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14
Q
A
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15
Q

How would you diagnose IE?

A
  • Bedside
    • Modified Duke criteria
    • urinalysis - microscopic haematuria
    • ECG - look for HB
  • Bloods
    • normocytic anaemia
    • neutrophilia
    • high ESR/CRP
    • Rh factor +
  • Imaging
    • Echocardiogram - vegetations
    • Transoesophageal Echocardiogram
    • CT - look for emboli
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16
Q

Briefly describe what does the modified Duke criteria for infective endocarditis include?

A
  • Major criteria
    • Positive blood culture
    • new valvular regurgitation, (+) echocardiogram
    • Endocardial involvement
    • Positive echo findings (vegetations, abcess)
    • Dehiscence of prosthesis
  • Minor criteria
    • Predisposing valve or cardiac abnormality
    • Fever >38
    • Vascular phenomena
    • Embolic phenomenon
    • Immunological phenomena
    • Positive blood culture not meeting major criteria
    • Suggestive echo findings
  • Diagnosis = 2 major or 1 major + 3 minor or 5 minor
17
Q

How would you tx IE?

A
  • Abx
  • Surgery
    • valve debridement
    • valve reconstruction
18
Q

What type of abx is appropriate if its strep?

A
  • IV benzylpenicillin + low dose gentamicin
  • Vancomycin if penicillin allergy
19
Q

What are the signs of subacute bacterial endocarditis?

A
  • finger clubbing
  • roth spots (retinal haemorrhage with pale centre)
  • Osler nodes
  • Janeway lesions
20
Q

What type of abx is appropriate if its enterococci?

A
  • IV amoxicillin + low dose Gentamicin
  • Vancomycin if pen allergy
21
Q

What type of abx is appropriate if its staph?

A
22
Q

How would you monitor IE’s response to tx?

A
  • Echo - once weekly
    • assess vegetation size
    • look for valve destruction, intracardiac abcesses
  • ECG - twice weekly
    • detect conduction disturbancs - sign of aortic root abcess
  • Blood test - twice weekly
    • ESR, CRP, FBC, U&Es
23
Q
A

Cardiology (15 decks)

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