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JL Cardiovascular > Infective Endocarditis and other Cardiac Infections > Flashcards

Infective Endocarditis and other Cardiac Infections Flashcards

1
Q

What is it easy to contaminate blood cultures with?

A

Skin organisms by using poor technique

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2
Q

If the organism is Streptococcus pneumonia, where is the likely focus of infection?

A

Pneumonia or meningitis

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3
Q

If the organism is E.coli/Klebsiella/other coliforms, where is the likely focus of infection?

A

Urinary tract or gut

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4
Q

If the organism is Staphylococcus aureus, where is the likely focus of infection>

A

Skin, wound infection, bone/joint infection, endocarditis

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5
Q

What is the commonest ‘coagulase negative staphylococcus’?

A

Staphylococcus epidermidis

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6
Q

What is often a skin contaminent but can infect prosthetic material e.g. intravascular line infections, prosthetic heart valves/joints?

A

Staphylococcus epidermidis

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7
Q

What is Corynebacterium sp. (“diphtheroids”)?

A

Another skin contaminant

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8
Q

What is the term for infection of the endothelium of the heart valves?

A

Infective endocarditis

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9
Q

What are hosptial-aquired cases of infective endocarditis increasing due to?

A

Staphylococcus aureus

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10
Q

Give 4 infective carditis pre-disposing factors?

A
  1. Heart valve abnormality
  2. Prosthetic heart valve
  3. IV drug users
  4. Intravascular lines
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11
Q

What are three heart valve abnormalities that can lead to infective endocarditis?

A
  1. Calcification/sclerosis in elderly
  2. Congenital heart disease
  3. Post rheumatic fever
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12
Q

What are the 5 steps in the pathogenesis of endocarditis?

A
  1. Heart valve damaged
  2. Turbulent blood flow over roughened endothelium
  3. Platelets/fibrin deposited
  4. Bacteraemia (may be very transient) e.g. from dental treatment
  5. Organisms settle in fibrin/platelet thrombi becoming a microbial vegetation
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13
Q

In infective endocarditis, what can happen to infected vegetations?

A

They become friable and break off, becoming lodged in the next capillary bed they encounter causing abscesses or haemorrhage

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14
Q

What side, and what valves are normally affected in infective endocarditis?

A

Left side of heart

Mitral and aortic valves

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15
Q

List the 4 organisms causing endocarditis native valve

A
  1. Staphylococcus aureus (38%)
  2. Viridans streptococci (31%0
  3. Enterococcus sp (8%)
  4. Staphylococcus epidermidis (6%)
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16
Q

Name 6 unusual/ atypical organisms causing endocarditis?

A
  1. Bartonella
  2. Coxiella burnetii (Q-fever0
  3. Chlamydia
  4. Legionella
  5. Mycoplasma
  6. Brucella
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17
Q

Other than atypical organisms causing endocarditis, what other two organisms can do it?

A

Gram-negatives

Fungi

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18
Q

What are the two presenting symptoms of acute endocarditis?

A
  1. Overwhelming sepsis

2. Cardiac failure

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19
Q

What organism is the common cause of addressive (virulent), acute endocarditis?

A

Staphylococcus aureus

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20
Q

What kind of murmur would indicate endocarditis?

A

New or changing murmur

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21
Q

Will endocartidis patients present pyrexial?

A

Yes

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22
Q

Give 5 clinical signs of endocarditis found on the hands/nails?

A
  1. Finger clubbing
  2. Splinter haemorrhages
  3. Roth spots
  4. Janeway lesions
  5. Osler nodes
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23
Q

What should be done first to diagnose infective endocarditis?

A

Take three sets of blood cultures

24
Q

If blood cultures return negative, what should you consider?

A

Serology for atypical organisms

25
Once blood cultures have been taken, what is the next diagnostic step?
Echocardiogram (transoesophageal)
26
What type of endocarditis: patient is usually infected at time of valve insertion and usually due to Staphylococcus epidermidis or Staphylococcus aureus?
Early prosthetic valve endocarditis
27
In early prosthetic valve endocarditis, what two organisms are usually to blame?
1. Staphylococcus epidermidis | 2. Staphylococcus aureus
28
What type of endocarditis is present in IV drug users?
Right sided endocarditis (tricuspid valve)
29
What organism is usually occurent in IV drug user endocarditis?
Staphylococcus aureus
30
What does IV drug user endocarditis often present as?
Staphylococcus aureus pneumonia
31
What type of administration of antibiotics is required for endocarditis?
High-dose, frequent IV antibiotics required
32
What antibiotics treat native valve endocarditis?
Amoxicillin and gentamicin IV
33
What antibiotics treat prosthetic valve endocarditis?
Vancomycin and gentamicin IV & rifampicin PO but usually valve replacement is required
34
What antibiotic treatment is used for drug user endocarditis?
Flucloxacillin IV
35
What antibiotic is used for Staphylococcus aureus?
Flucloxacillin IV
36
What antibiotics treat MRSA?
Vancomycin IV and rifampicin PO
37
What antibiotics treat viridans streptococci?
Benzylpenicillin and gentamicin IV
38
What antibiotics treat Enterococcus sp.?
Amoxicillin/vancomycin and gentamicin IV
39
What treats Staphylococcus epidermidis?
Vancomycin and gentamicin IV and rifampicin PO
40
For monitoring antibiotics therapy, how long are they usually given for?
4-6 weeks
41
What three factors should be monitored during treatment of endocarditis?
Cardiac function Temperature Serum C-reactive protein (CRP)
42
What are patients with heart valve lesions, congenital heart defects or prosthetic heart valve at risk of?
Endocarditis
43
What is antibiotic prophylaxis treatment required in?
When having gastrointestinal or genitourinary tract procedures
44
What si myocarditis?
Inflammation of cardiac muscle
45
Who is myocarditis commoner in and what can it cause?
Young people - sudden death
46
What two signs are found in myocarditis?
Arrythmia | Cardiac failure
47
What two viruses mainly cause myocarditis?
Coxsackie A & B Echovirus mainly enteroviruses
48
How is myocarditis diagnosed?
By viral PCR
49
How are enteroviruses diagnosed?
Throat swab and stool
50
How is influenza for myocarditis diagniosed?
Throat swab
51
What is pericarditis?
Inflammation of pericardium
52
What condition often occurs with myocarditis?
Pericarditis
53
What is the main clinical feature of pericarditis?
Chest pain
54
What condition is main causeed by viral aetiology, but can occur by bacteria e.g. after cardiothoracic surgery?
Pericarditis
55
What is the term for bacteria in the blood stream?
Bacteraemia or septicaemia

JL Cardiovascular (18 decks)

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