Infective Endocarditis and other Cardiac Infections

Question 1

is blood sterile?

Answer 1

YES

Question 2

What happens if there is bacteria in the blood (bacteraemia)?

Answer 2

patient may develop septic shock and die.

Question 3

what are skin organisms?

Answer 3

Staphylococcus aureus
Staphylococcus epidermidis
Corynebacterium sp.
Propionibacterium acnes

Question 4

what types of bacteria will form around and on cardiac implantable electronic devices?

Answer 4

skin organisms
biofilm forma
anatomic location of infection
difficult to diagnose

Question 5

d: infective endocarditis

Answer 5

Infection of the endothelium of the heart valves

Life threatening - often diagnosed late

Question 6

predisposing factors of infective endocarditis?

Answer 6

Heart valve abnormality:
-calcification/sclerosis in elderly
-congenital heart disease
-post rheumatic fever
Prosthetic heart valve
Intravenous drug users
Intravascular lines

Question 7

pathogenesis of endocarditis

Answer 7

Heart valve damaged
Turbulent blood flow over roughened endothelium
Platelets / fibrin deposited
Bacteraemia (may be very transient) e.g. from dental treatment
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 - may be fatal

Usually left side of heart affected (mitral and aortic valves)

looks like a cauliflour apparently

Question 8

staphylcoccus aureus causing endocarditis tends to present acute/sub-acute?

Answer 8

acute

Question 9

Unusual organisms causing endocarditis?

Answer 9

Atypical organisms
Bartonella, Coxiella burnetii (Q-fever), Chlamydia, Legionella, Mycoplasma, Brucella
Gram-negatives
HACEK organisms
Haemophilus spp. , Aggregatibacter spp, ( was Actinobacillus) , Cardiobacterium, Eikenella sp., Kingella sp.
Non HACEK gram negatives
Fungi

Question 10

is staph aureus coagulase positive or negative?

Answer 10

positive

Question 11

if you know its Gram-positive cocci in clusters what is the treatment?

Answer 11

staph

flucoxacillin

Question 12

symptoms infective endocarditis

Answer 12

Presents as overwhelming sepsis and cardiac failure

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

Question 13

subacute presentation symptoms endocarditis

Answer 13

Fever
malaise
Weight loss
Tiredness
Breathlessness

Question 14

signs of endocarditis on examination

Answer 14

Fever
New or changing heart murmur
finger clubbing
splinter haemorrhages
splenomegaly
Roth spots, Janeway lesions, Osler nodes
microscopic haematuria

Question 15

symptoms myocarditis

Answer 15

fever, chest pain, shortness of breath, palpitations

sudden death

Question 16

signs examination on myocarditis

Answer 16

arrhythmia

cardiac failure

Question 17

cause of myocarditis

Answer 17

Mainly caused by enteroviruses -Coxsackie A & B, echovirus, but other viruses possible the list is extensive.

Question 18

diagnoses myocarditis

Answer 18

Diagnosed by viral PCR. Throat swab and stool for enteroviruses. Throat swab for influenza

Question 19

treatment of myocarditis

Answer 19

supportive treatment

Question 20

main symptom pericarditis

Answer 20

chest pain

Question 21

cause of pericarditis and treatment

Answer 21

Viral aetiology mainly, Supportive or pneumonia treatment : antibiotics & drainage