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Cardiovascular > Infective Endocarditis and Other Cardiac Infections > Flashcards

Infective Endocarditis and Other Cardiac Infections Flashcards

1
Q

describe blood cultures

A

blood is normally sterile
the presence of bacteria in the bloodstream (bacteraemia) is a potentially life threatening event- if not treated promptly the patient may develop septic shock and die

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2
Q

which organisms are commonly found in cardiac implantable electronic devices?

A 
staphylococcus aureus
staphylococcus epidermidis
corynebacterium sp.
proprionibacterium acnes
a biofilm can form
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3
Q

risk factors for ICED infections

A 
pre procedure prophylaxis
complexity of procedure
temporary pacer use
type of device
number of revisions/ reinterventions
fever within 24 hours
heart failure, renal failure
haematoma post procedure
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4
Q

generator pocket infection

A 
localised cellulitis
pain
swelling
discharge
wound breakdown
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5
Q

clinical features of ICED-IE/ ICED-LI

A

non specific signs and symptoms of systemic infection including fevers, chills, night sweats, malaise and anorexia
may present with secondary foci such as spinal or pulmonary infection

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6
Q

what can be used to assist in the diagnosis of ICED-ID/ ICED-LI

A

Duke Criteria

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7
Q

infective endocarditis

A

infection of the endothelium of the heart valves
life threatening
may be acute or subacute

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8
Q

predisposing factors to infective endocarditis

A 
heart valve abnormality
- calcification/ sclerosis in elderly
- congenital heart disease
- post rheumatic fever
prosthetic heart valve
intravenous drug users
intravascular lines
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9
Q

pathogenesis of endocarditis

A

heart valve damaged
turbulent blood flow over roughened endothelium
platelets/ fibrin deposited
bacteraemia
organisms settle in fibrin/ platelet thrombi becoming a microbial vegetation
infected vegetations are friable and break off, becoming lodged in the next capillary bed they encounter causing abscesses or haemorrhage
usually left side of heart affected (right side in drug users)

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10
Q

organisms causing endocarditis native valve

A

staphylococcs aureua
viridans group streptococci
enterococcus
staphylococcus epidermidis

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11
Q

unusual organisms causing endocarditis

A 
atypical
- bartonella
- coxiella burnetti
- chlamydia
- legionella
- mycoplasma
- brucella
gram negatives
- HACEK organisms 
- haemophilus
- aggregatibacter
- cardiobacterium
- eikenella
- kingella
- non HACEK gram negatives
fungi
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12
Q

blood cultures positive for an IE

A

detection of an endocarditis specific pathogens in 2 independant blood cultures
-or-
microorganisms compatible with an IE persistenly positive blood cultures
-or-
a single positive blood culture with coxiella burnetti or a phase I IgG antibody titer > 1:800

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13
Q

taking blood cultures

A

Take 3 sets of blood cultures -very important since if all are positive there is good evidence of continuing bacteraemia. If only one set taken and is positive might be a contaminant. Better clinical outcome when causative organism is identified
Should be taken before any antibiotics
If blood cultures negative, consider serology for “atypical” organisms

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14
Q

staph epidermidis

A

Most common coagulase-negative Staphylococcus
Often a skin contaminant, BUT can infect prosthetic material e.g. Intravascular line infections, prosthetic heart valves/joints
Take more than one set of blood cultures to confirm significance

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15
Q

common skin contaminants

A

staph epidermidis

corynebacterium

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16
Q

presenting symptoms of acute endocarditis

A

Presents as overwhelming sepsis and cardiac failure

Usually due to aggressive (virulent) organisms such as Staphylococcus aureus

17
Q

symptoms of subacute endocarditis

A 
fever
malaise
weight loss
tiredness
breathlessness
18
Q

signs of subacute endocarditis

A 
fever
new or changing heart murmur 
finger clubbing 
splinter haemorrhages
splenomegaly
roth spots
janeway lesions
osler nodes
microscopic haematuria
19
Q

viridans group streptococci

A 
alpha haemolytic strep
- strep mitis
- strep sanguinis
- strep mutans
- strep salvarius
subacute endocarditis
- normal oral commensals
- no lancefield group or capsule
20
Q

investigations for infective endocarditis

A

transthoracic echocardiography

transoesophageal echocardiography

21
Q

positive echocardiography for an IE

A

vegetation, abscess, pseudonaneurysm, intracardiac fistula, valve preforation, new partial dehiscence of a valve prothesis

22
Q

prothetic valve endocarditis

A

Early (within 60 days) and late presentations
Early- usually infected at time of valve insertion and usually due to Staphylococcus epidermidis or Staphylococcus aureus
Late - up to many years after valve insertion - due to co-incidental bacteraemia. Wide range of possible organisms

23
Q

endocarditis in PWID

A

Right-sided endocarditis (tricuspid > >mitral > aortic)
Usually Staphylococcus aureus
Suspect in Staphylococcus aureus plus septic pulmonary emboli

24
Q

treatment for native valve endocarditis (viridans strep)

A

amoxicillin and gentamicin IV

25
Q

treatment for prosthetic valve endocarditis

A

vancomycin and gentamicin IV
add in day 3 to 5 rifampicin PO
often valve replacement

26
Q

treatment of drug user endocarditis (MSSA)

A

flucloxacillin IV

27
Q

staphyloccocus aureus treatment

A

flucloxacillin IV

28
Q

MRSA treatment

A

treat as per prosthetic valve

29
Q

viridans strep treatment

A

benzylpenicillin IV and gentamicin IV

30
Q

staph epidermidis treatment

A

vancomycin and gentamicin IV

rifampicin PO

31
Q

monitoring treatment

A

IV antibiotics usually given for 4-6 weeks
Monitor cardiac function, temperature and serum C-reactive protein (CRP)
If failing on antibiotic therapy, consider referral for surgery early

32
Q

patient characteristics increasing mortality

A

older age
prosthetic valve IE
diabetes mellitus
comorbidity

33
Q

clinical complications increasing mortality

A 
heart failure 
renal failure 
moderate area of ischaemic stroke 
brain ahaemorrhage
septic shock
34
Q

microorganisms increasing mortality

A

staph aureus
fungi
non HACEK gram- bacilli

35
Q

myocarditis

A

more common in young people
mainly causes by enteroviruses- Coxsackie A & B, echovirus, but other viruses possible the list is extensive.
Diagnosed by viral PCR. Throat swab and stool for enteroviruses. Throat swab for influenza
Supportive treatment

36
Q

symptoms of myocarditis

A

fever
chest pain
SoB
palpitations

37
Q

signs of myocarditis

A

arrhythmia

cardiac failure

38
Q

pericarditis

A

Often occurs with myocarditis
Chest pain main feature
Viral aetiology mainly, Supportive treatment
bacteria less common
e.g post cardiothoracic surgery, rarely secondary spread from endocarditis or pneumonia treatment : antibiotics & drainage

Cardiovascular (31 decks)

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