infective endocarditis and rheumatic heart disease

Question 1

Identify the aetiology and predisposing factors of infective endocarditis. Recognise the most common microorganisms involved..

Answer 1

inflammation of the endocardium which is the inner layer of the heart. usually involves the valves and characterised by vegetations made of fibrin, platelets and micro-organism

Question 2

Describe the most common symptoms and signs of infective endocarditis

Answer 2

fever- chills/rigors
poor apepetite
weigh loss
heart murmur

Question 3

modified duke criteria

Answer 3

definite IE if you have 2 major or 1 major and three minor
possible IE if you have 1 major and 1 minor or 3 minor

Question 4

Outline the management of infective endocarditis, including the indications for cardiac surgery.

Answer 4

ampicillin+flucloxacillin+gentamicin
uncontrolled infection
large vegetation >10mm
heart failure with valvular dysfunction or cardiac complications

Question 5

Characterise the incidence/prevalence and global distribution of rheumatic heart disease in the world.

Answer 5

very common In low and middle income countries. common in the south

Question 6

Describe long term effects of rheumatic heart disease.

Question 7

what antibiotic therapy should you do if you have prosthetic valves

Answer 7

rifampicin and gentamicin for at least 6 weeks

Question 8

what is vegetation

Answer 8

masses on the valves

Question 9

how do you diagnose IE

Answer 9

elevated C-reactive protein, erythrocyte sedimentation, anaemia
blood cultures- 3 sets 30 mins apart

Question 10

most commons organism that cause IE

Answer 10

staphylococcus aureus
streptococci
enterococci
staph is more common than strep

Question 11

diagnosis imaging of IE

Answer 11

echocardiogram to look for vegetation/ absesses
trasnoesophageal echo for people with prosthetic valves
CT/MRI to interpret emboli

Question 12

development of rheumatic heart disease

Answer 12

1. group A beta-haemolytic strep infection lasting 2-3 wks
2. acute rheumatic fever(sore joints) for years
3. leads to chronic RHD

Question 13

diagnosis of rheumatic heart disease

Answer 13

dyspnoea and symptoms of heart failure
ECG- left atrial/ventricular enlargement
CXR- enlarged left atrium/ventricle and signs of pulmonary venous congestion

Question 14

which valves does RHD commonly affect

Answer 14

left sided valves so more likely to have mitral stenosis or regurgitation

Question 15

treatment of RHD

Answer 15

diuretics
vasodilators
AF- digoxin/ beta blockers and anticoagulants

Question 16

what is vavuloplasty

Answer 16

balloon mitral vavuloplsty via femoral vein up into SVC and into right atrium if not possible then prosthetic options available.