Infective Endocarditis and Rheumatic Heart Disease Flashcards
Define endocarditis
Endocarditis is the inflammation of the endocardium (inner layer of the heart). Endocarditis begins as a genralised infection in the blood stream. Charecterised by vegetations: platelets, firbin and microorganisms. This infection involve the valves of the heart
What is the clinical presnetation of endocarditis?
- Embolic stroke
- Pulmonary embolism
- Myocardial infarction
- Infaction of kidney, spleen, mesenteric, skin
- Immune respone
Why is the clinical presentation highly variable?
Presentation can be highly variable. Can be acute and fulminant, mostly is subacute or chronice. Vegetations can move around the body from the left and right side of the heart and therefore can have very different presentations
What are the predisposing conditions for someone to develop endocarditis?
- Prosthetic valves
- Cardiac devices
- Intravenous drug users
- Congenital heart disease
- Rheumatic valve disease
- Mitral valve prolapse
- Immunosuppression
- Prolonged admission to ITU/hospital
What are the signs and symptoms of endocarditis?
Fever
Chills/rigors
Poor appetite
Weight loss
Heart murmur
What are the clinical examination findings of endocarditis?
Osler nodes
Janeway lesions
Splinter heamorhage
How do you diagnose endocarditis?
Look for signs of infection in blood test.
Endocarditis is usually caused by the common agents staphyloccus aureus, stretococci, enterococci, coagulase negative staphylococci. HACEK group can also cause endocarditis but it is less common.
What happens if the blood culture is negative for endocarditis?
They can still have the pathogen that could cause the endocardiitis but it will not be picked up in the blood cultures.
There is bacteria and fungi which can be picked up at a later date. More specific test can be done to find them
WHt are the other conditions if patients don’t definetley have endocarditis and are not infection?
Systemic Lupus
Marantic endocarditis
What imaging is used for endocarditis?
- Transthoracic echo
- Transoesophgeal echo
- CT/MRI
- Positron emission tomography
- FDG PET/CT
What is the major diagnostic criteria in the modifidied duke criteria for infective endocarditis?
Blood culture positive for typicla microorganisms (staphylococcus aureus, enterococcus, viridans streptococci)
Echocardiogram showing valvular vegetation
What is the minor criteria for infective endocarditis in the modified duke criteria?
- Predisposing cardiac lesion
- Intravenous drug use
- Temperature >28C
- Embolic pneumonena
- Positive blood culture not meeting above criteria
What is the diagnosis for definitive infective endocarditis?
2 major or 1 major + 3 minor criteria
What is the diagnosis for possible infective endocarditis?
1 major + 1 minor or 3 minor criteria
What is the prognosis of endocarditis?
- Patient characteristics - Older age, comodibidities and diabetes
- infective microorganisms - Staph aureus and fungi
- Presnece of cardiac/noncardiac complications - HF, rebak failure, ischeamic stroke, shock
- Echocardiographic findings - Periannular complications, severe valve regurgitation, low systolic function and large vegetations
What is the treatment of endocarditis?
Antibiotic: If patient has endocarditis due to streptococci then penicillin is given with or without vancomnyocin. Patients with staph aureus, flucloxacillin is given
What are the indications of cardiac surgery for infective endocarditis?
- Heart failure with valvular dysfunction or cardiac complications
- Uncontrolled infection: Persistent fever and positive blood cultures
- Prevention of embolism: If the vegetation is persistently large (>10mm). If there is one or more emoblic episodes
How does rheumatic heart disease start off?
Rheumatic heart disease starts with group A beta-haemolytic strep infection (strep pharyngitis) usually is seen in 5-15 year olds
What happens after 2-3 weeks later if someone may have rheumatic heart disease?
After 2-3 weeks it may develop into acute rheumatic fever: Cardiitis + painful joints. Not the most common representation of rheumatic heart disease. Could be seen alongside with pericarditis/valvulitis.
When will rheumatic heart disease develop?
After years it will develop into rhuematic heart disease: progressive valvular diseases after years of rheumatic fever. Can present clinically or sibclinically for years.
What is the clinical presentation of rheumatic heart disease?
Patients will present with dysponea and symptoms of heart failure
How is rheumatic heart disease seen in investigation?
ECG: Consistent with atrial fibrillation.
CXR: Pulmonary eodema
Echocardiography: RHD typically affects the left-sided valves with greater affinity and consequences for the mitral valve.
What is the treatment of rheumatic heart disease?
Secondary prevention: Penicillin prophylaxis
- Diuretics
- Vasodilators: ACEi/ARB
- Treatemnt of AF: Betablockers/Digoxin and anticoagulation (WARFARIN)
How do you trea
