Infective Endocarditis Cases Flashcards
Risk factors Infective endocarditis
abnormal valves
risk of bactermia
predisposing heart conditions
prosthetic valves
mitral prolapse with regurgitation or thickened leaflets
rheumatic HD
complex congenital HD
Mitral regurg, aortic stenosis, aortic regurg, ventricular spetal defect
predisposing procedures (5)
dental work or poor hygiene (esp w/bleeding)
skin disruption
hemodialysis
IV drugs
focal infection with typical organism
infective endocarditis clinical presentaion
fever
heart murmur
chills, sweats
anorexia, alaise, weight loss
noncardiac manifestations
lab abnormalities
non-cardiac manifestations of infective endocarditis (5)
emboic events
splenomegaly
clubbing
petechiae
other (splinters, Oslers, Janeways, roths)
osler nodes
tender violaceous subq lesions in finger or toe pads (no hemmorhagic)
janeway lesions
nontender eryhtematous or hemorrhagic macules or papules in fingertips, palms, soles
(due to septic emboli)
roth spots
retinal lesions with hemorrhagic white central spot
lab abnormalities
anemia
leukocytosis
microscopic hematuria
elevated sed rate and CRP
prothetic valves most likely…
coag neg staph
acute most likely
staph a
elderly manifestations most likely
enterococcus
unusual causes
gram neg rods
candida
culture negative endocarditis causes
HACEK group
nutrionally variant strep (abiotrophia)
Coxiella burnetti,
Bartonella
Brucella
Tropheryma whipplei
most sensitive echo
TEE
Major duke criteria
Microbiologic - typical organism from 2 separate blood cxs OR organism from persistent blood cxs OR positive serology for C brunetti
Evidence of endocardial involvement - new vavlular regurg or +echo
Dukes minor criteria (5)
Fever
Prediposition (cardiac abrml or IV drugs)
Vascular phenom
Immuologic phenom (RF, glomeruloneph, Oslers or Roths)
microbiologic not meeting major criteria
Rx for penicillin susceptible strep
penicillin or ceftriaxone,
Vanco
Rx for enterococci
Pen or amp with gentamicin
Vanco with gentamicin
Rx for staph on native valve
Nafclillin or oxacillin (+/- gentamicin)
Cefazolin (+/- gentamicin)
Vanco
Rx staph on prosthetic valve
Nacillin or Oxacillin AND rifampin (+/- gentamicin)
Vanco AND rifampin (+/- Gent)
Rx HACEK
ceftriaxone
Amp/sulbactam
Ciprofloxacin
indications for surgery
CHF
prosthetic
performation or rupture
new heart block
multiple embolic events
uncontrolled infection
poorly treated wit Rx (fungi)
prolonged fever in IE most likely due to
S aureus
GNR
Fungi
mycotic aneurisms
most common with viridans sprep
lining infected blood vessels
direct emolization/infection of wall or immune complex depos
dental prophylatic Rx
amoxicillin 20g PO
clindamycin
ampicillin 2g IV
ceftriaxone 1g IV
