Infective Endocarditis Cases

Question 1

Risk factors Infective endocarditis

Answer 1

abnormal valves

risk of bactermia

Question 2

predisposing heart conditions

Answer 2

prosthetic valves

mitral prolapse with regurgitation or thickened leaflets

rheumatic HD

complex congenital HD

Mitral regurg, aortic stenosis, aortic regurg, ventricular spetal defect

Question 3

predisposing procedures (5)

Answer 3

dental work or poor hygiene (esp w/bleeding)

skin disruption

hemodialysis

IV drugs

focal infection with typical organism

Question 4

infective endocarditis clinical presentaion

Answer 4

fever

heart murmur

chills, sweats

anorexia, alaise, weight loss

noncardiac manifestations

lab abnormalities

Question 5

non-cardiac manifestations of infective endocarditis (5)

Answer 5

emboic events

splenomegaly

clubbing

petechiae

other (splinters, Oslers, Janeways, roths)

Question 6

osler nodes

Answer 6

tender violaceous subq lesions in finger or toe pads (no hemmorhagic)

Question 7

janeway lesions

Answer 7

nontender eryhtematous or hemorrhagic macules or papules in fingertips, palms, soles

(due to septic emboli)

Question 8

roth spots

Answer 8

retinal lesions with hemorrhagic white central spot

Question 9

lab abnormalities

Answer 9

anemia

leukocytosis

microscopic hematuria

elevated sed rate and CRP

Question 10

prothetic valves most likely…

Answer 10

coag neg staph

Question 11

acute most likely

Answer 11

staph a

Question 12

elderly manifestations most likely

Answer 12

enterococcus

Question 13

unusual causes

Answer 13

gram neg rods

candida

Question 14

culture negative endocarditis causes

Answer 14

HACEK group

nutrionally variant strep (abiotrophia)

Coxiella burnetti,

Bartonella

Brucella

Tropheryma whipplei

Question 15

most sensitive echo

Answer 15

TEE

Question 16

Major duke criteria

Answer 16

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

Question 17

Dukes minor criteria (5)

Answer 17

Fever

Prediposition (cardiac abrml or IV drugs)

Vascular phenom

Immuologic phenom (RF, glomeruloneph, Oslers or Roths)

microbiologic not meeting major criteria

Question 18

Rx for penicillin susceptible strep

Answer 18

penicillin or ceftriaxone,

Vanco

Question 19

Rx for enterococci

Answer 19

Pen or amp with gentamicin

Vanco with gentamicin

Question 20

Rx for staph on native valve

Answer 20

Nafclillin or oxacillin (+/- gentamicin)

Cefazolin (+/- gentamicin)

Vanco

Question 21

Rx staph on prosthetic valve

Answer 21

Nacillin or Oxacillin AND rifampin (+/- gentamicin)

Vanco AND rifampin (+/- Gent)

Question 22

Rx HACEK

Answer 22

ceftriaxone

Amp/sulbactam

Ciprofloxacin

Question 23

indications for surgery

Answer 23

CHF

prosthetic

performation or rupture

new heart block

multiple embolic events

uncontrolled infection

poorly treated wit Rx (fungi)

Question 24

prolonged fever in IE most likely due to

Answer 24

S aureus

GNR

Fungi

Question 25

mycotic aneurisms

Answer 25

most common with viridans sprep

lining infected blood vessels

direct emolization/infection of wall or immune complex depos

Question 26

dental prophylatic Rx

Answer 26

amoxicillin 20g PO

clindamycin

ampicillin 2g IV

ceftriaxone 1g IV