Infective endocarditis Flashcards
Name signs and symptoms of infective endocarditis
Fever Heart murmurs Splenomegaly Pallor FTT Cardiac failure Cardiac arrythmia Pericardial/pleural rub Abdominal symptoms Neurological symptoms Classic signs
What signs of neurological disease are seen in infective endocarditis?
Focal neurological deficit (paralysis, hemiparesis, aphasia)
ICH (stiff neck, delirium)
Multiple microabscess
Conjunctival haemorrhage
What signs of abdominal disease are seen in infective endocarditis?
RUQ pain
Vomiting
Appendicitis-like
What are the classic signs of IE?
Petechiae Splinter haemorrhages Osler nodes Janeway lesions Roth spots
Give the major criteria for IE
2 + blood cultures more than 12 hours apart OR 3 or more 1 hour apart
Echo
- oscillating intracardiac mass
- myocardial abscess
- prosthetic valve dehiscence
- new onset valvular regurg
Give the minor criteria for IE
Predisposing heart condition IV drug use Fever > 38 Vascular phenomena Immunological phenomena \+ blood culture Consistent echo
How do you diagnose IE?
2 major
1 major 3 minor
5 minor
What vascular phenomena are seen in IE?
Major arterial emboli Septic pulmonary infarct Mycotic aneurysm ICH Conjunctival haemorrhage Janeway lesions
What immunological phenomena are seen in IE?
Glomerulonephritis
Osler nodes
Roth spots
+ RhF
What is the aetiology of IE?
Turbulent blood flow and superimposed bacteremia
Turbulence exposes collagen -> coagulation cascade activated -> bacteremia attracted to clots -> vegetations
What are the 2 main types of IE?
Acute (normal heart, aggressive bacteria)
Sub-acute (abnormal heart, mild bacteria)
Discuss the management of IE
Eradicate the bacteria Address the complications 1. Antibiotics - empirical: ampi, cloxa, gentamycin - continue with adjusted according to culture for 6 weeks (4 IVI, 2 oral) 2. Treat CHF 3. Oxygen 4. Haemodialysis
When should you consider other antibiotics in IE?
Deep line VP shunt Immunosuppression Suspected MRSA (vanco) Nosocomial infection (meropenem)
Which patients are high risk and should be considered for IE prophylaxis?
Congenital HD with high pressure lesion CCCHD Prosthetic heart valve Prosthetic material History of IE Post transplant cardiac valvulopathy
What prophylaxis can you give for infective endocarditis?
Amoxicillin 50mg/kg stat 1hr before surgery
Ampicillin 50mg/kg IV 30 min before surgery
Allergy - erythromycin, clindamycin
GIT procedure - add gentamycin 1.5mg/kg 30 min before surgery
