Infective endocarditis and rheumatic heart disease

Question 1

Infective endocarditis definition

Answer 1

infection involving the endocardial surface

Question 2

IE is a deadly disease with

Answer 2

high mortality and sever complications

Question 3

IE incidence

Answer 3

rare disease with a low incidence

Question 4

Risk factors for IE

Answer 4

mitral valve disease

rheumatic heart disease

congenital heart disease

degenerative heart disease

asymmetrical septal hypertrophy

IV drug users

Diabetes

prosthetic valve

Question 5

deposition of fibrin and platelets leads to

Answer 5

non-bacterial thrombotic endocarditis (NBTE)

Question 6

NBTE facilitates

Answer 6

bacterial adherence and infection

Question 7

normal valve endothelium is resistant to

Answer 7

colonisation and infection

Question 8

Pathophysiology for a damaged endothelial valve

Answer 8

turbulent blood flow

electrodes

catheters

inflammation

degenerative heart disease

Question 9

Aetiology of endocarditis

Answer 9

viridian’s group strep

staph aureus

enterococci

haemophilus parainfluenzae

fungi

strep bovis

Question 10

IE is not a uniform disease - diagnosis involves the

Answer 10

presence of multiple findings

Question 11

Common IE symptoms

Answer 11

fever/chills

night sweats, malaise, fatigue, anorexia

weakness

headache

SOB

Question 12

Clinical signs of IE

Answer 12

cardiac murmur

Janeway lesions

meningeal signs

splinter haemorrhage

osler nodes

roth spots

Question 13

Janeway lesions

Answer 13

haemorrhagic painless plaques

usually on palms and soles of feet

Question 14

Osler nodes

Answer 14

small, painful nodular lesion on pads of fingers and toes

Question 15

Investigations in IE

Answer 15

blood culture

FBC (elevated inflammatory markers)

U+Es

Urinalysis

ECG

CXR

Echo

Question 16

Dukes criteria for diagnosis

Answer 16

micro-organisms (culture/histological slide)

pathological lesions (janeway/roths)

vascular evidence (emboli, aneurysm)

high fever (over 38)

Question 17

Treatment

Answer 17

3 sets of blood taken before IV antibiotics

Question 18

Clinical complications of IE

Answer 18

heart failure

Renal failure

septic shock

uncontrolled infection

Question 19

Good oral hygiene is more important than …….. in order to reduce risk of IE

Answer 19

antibiotic prophylaxis

Question 20

Preventative measures

Answer 20

strict dental and cutaneous hygiene

disinfection of wounds

decrease in bacterial carriage (urine, skin)

curative antibiotics

no self-medication of antibiotics