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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
Q

Once blood cultures have been taken, what is the next diagnostic step?

A

Echocardiogram (transoesophageal)

26
Q

What type of endocarditis: patient is usually infected at time of valve insertion and usually due to Staphylococcus epidermidis or Staphylococcus aureus?

A

Early prosthetic valve endocarditis

27
Q

In early prosthetic valve endocarditis, what two organisms are usually to blame?

A
  1. Staphylococcus epidermidis

2. Staphylococcus aureus

28
Q

What type of endocarditis is present in IV drug users?

A

Right sided endocarditis (tricuspid valve)

29
Q

What organism is usually occurent in IV drug user endocarditis?

A

Staphylococcus aureus

30
Q

What does IV drug user endocarditis often present as?

A

Staphylococcus aureus pneumonia

31
Q

What type of administration of antibiotics is required for endocarditis?

A

High-dose, frequent IV antibiotics required

32
Q

What antibiotics treat native valve endocarditis?

A

Amoxicillin and gentamicin IV

33
Q

What antibiotics treat prosthetic valve endocarditis?

A

Vancomycin and gentamicin IV & rifampicin PO but usually valve replacement is required

34
Q

What antibiotic treatment is used for drug user endocarditis?

A

Flucloxacillin IV

35
Q

What antibiotic is used for Staphylococcus aureus?

A

Flucloxacillin IV

36
Q

What antibiotics treat MRSA?

A

Vancomycin IV and rifampicin PO

37
Q

What antibiotics treat viridans streptococci?

A

Benzylpenicillin and gentamicin IV

38
Q

What antibiotics treat Enterococcus sp.?

A

Amoxicillin/vancomycin and gentamicin IV

39
Q

What treats Staphylococcus epidermidis?

A

Vancomycin and gentamicin IV and rifampicin PO

40
Q

For monitoring antibiotics therapy, how long are they usually given for?

A

4-6 weeks

41
Q

What three factors should be monitored during treatment of endocarditis?

A

Cardiac function
Temperature
Serum C-reactive protein (CRP)

42
Q

What are patients with heart valve lesions, congenital heart defects or prosthetic heart valve at risk of?

A

Endocarditis

43
Q

What is antibiotic prophylaxis treatment required in?

A

When having gastrointestinal or genitourinary tract procedures

44
Q

What si myocarditis?

A

Inflammation of cardiac muscle

45
Q

Who is myocarditis commoner in and what can it cause?

A

Young people - sudden death

46
Q

What two signs are found in myocarditis?

A

Arrythmia

Cardiac failure

47
Q

What two viruses mainly cause myocarditis?

A

Coxsackie A & B
Echovirus

mainly enteroviruses

48
Q

How is myocarditis diagnosed?

A

By viral PCR

49
Q

How are enteroviruses diagnosed?

A

Throat swab and stool

50
Q

How is influenza for myocarditis diagniosed?

A

Throat swab

51
Q

What is pericarditis?

A

Inflammation of pericardium

52
Q

What condition often occurs with myocarditis?

A

Pericarditis

53
Q

What is the main clinical feature of pericarditis?

A

Chest pain

54
Q

What condition is main causeed by viral aetiology, but can occur by bacteria e.g. after cardiothoracic surgery?

A

Pericarditis

55
Q

What is the term for bacteria in the blood stream?

A

Bacteraemia or septicaemia

JL Cardiovascular (18 decks)

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