Infective endocarditis (Complete) Flashcards
What is infective endocarditis?
Infection of endovascular structures of the heart (e.g. heart valves)
What are the main risk factors for developing infective endocarditis? (9)
Age > 60
Male
IV drug use
Poor dentition or dental infections
Valvular disease or prosthetic valves
Congenital heart diseases
HIV
Central catheters or shunts
Haemodialysis
What are the most common infective organisms which can cause infective endocarditis?
In order of incidence:
Staphylococcus aureus
Streptococcus viridans
Streptococcus bovis (colorectal cancer and IBD patients predisposed to this infection which can also cause infective endocarditis)
Enterococci
Fungi
HACEK organisms
What are the main symptoms of infective endocarditis? (8)
Fever
Pleuritic chest pain
Abdominal pain
Headache
Cough
Anorexia
Systemic features such as: Weight loss, Night sweats
Myalgia and arthralgia
What clinical signs on examination can present in patients with infective endocarditis? (6)
New murmur
Janeway lesions (palms or soles)
Oslow nodules (finger pads or toes)
Splinter haemorrhages
Roth spots (White centered retinal heamorrhages)
Microscopic haematuria
Clubbing
What investigations should be ordered in patients suspected of having infective endocarditis?
Bedside:
ECG: Check for HF or other complications. Can see PR elongation in some patients if the have an aortic root abscess.
Urinalysis: Microscopic haematuria
Bloods:
Blood cultures
FBC
CRP
U&Es
LFTs
Imaging:
Transthoracic echocardiogram (1st line)
Transoesophageal ECHO (2nd line. More sensitive but more invasive so only used if negative findings on thoracic echo but still high suspicion of IE)
CXR
How should blood cultures be taken when trying to investigate for infective endocarditis?
At least 3 blood cultures at different times and various sites
What criteria is used to diagnose infective endocarditis?
Dukes criteria
To be diagnosed must meet either of the following:
* 2 major criteria
* 1 major and 3 minor criteria
* 5 minor criteria
What are the major criteria for diagnosis of infective endocarditis according to Dukes Criteria? (2)
Positive blood culture
Positive echocardiogram
What are the minor criteria for diagnosis of infective endocarditis according to Dukes Criteria? (5)
Pre-disposing Heart or valve condition or IV drug use
Fever >38 degrees
Vascular phenomena: (e.g. janeway lesions, splinter haemorrhages, petechiae, clubbing)
Immunological phenomena (e.g. glomerulonephritis, osler’s nodes, roth spots)
Microbiological evidence that does not meet major criteria (e.g. serological findings of organism or one blood culture positive finding)
What is the management plan for patients with infective endocarditis?
Pharmacological:
Long-term broad spectrum IV ABs(6 weeks minimum) [e.g. amoxicillin]
Surgery if evidence of valvular damage, cardiac failure, emboli, infection resistance or aortic abscess
List examples of indications for surgery in patients with infective endocarditis. (6)
Haemodynamic instability
Heart failure
Valvular damage (or prosthetic damage)
Recurrent emboli
Aortic root abscess
Irresponsiveness to ABs
Is prophylaxis reccomended for infective endocarditis?
No evidence of prophylaxis (e.g. ABs) being beneficial in prevention of infective endocarditis.
Brushing teeth excessively can actually increase risk of bactaraemia
What 3 main complications can arise in patients with infective endocarditis? (3)
Embolisation
Acute heart failure
Acute kidney injury
What infective organism is present in IBD/Colon cancer patients which can result in infective endocarditis?
Streptococcus bovis
