Infective Endocarditis - Exam 1 Flashcards
Define infective endocarditis. What are 3 common sources? Is left or right sided more common?
infection caused by bacteria that enter the bloodstream and settle into the heart lining, heart valve, or a blood vessel (AHA)
Dental procedures
IV drug use
Indwelling catheters
LEFT is more common in everyone except IVDU
What are the risk factors for infective endocarditis?
previous endocarditis
prosthetic valve or pacemaker
valvular/congenital heart disease
IVDU
intravenous catheter
immunosuppression
recent dental/surgical procedure
**______ is the most common pathogen that effects native valves. What is 2nd MC?
Stap- MC
Strep- 2nd MC
infective endocarditis for prosthetic valves that occur within the first TWO MONTHS is ______. After the initial window it is ______
early- Staph
late- strep
What is the MC pathogen for infective endocarditis for IVDU? What is the MC valve effect for IVDU?
Staph- MC
then strep and enterococci
tricuspid valve
_____ is the MC pathogen for infective endocarditis due to nosocomial infections
staph aureus
What are the most common types of pts who have fungal infective endocarditis? What are the two most common fungi?
IVDU and pts who receive broad spectrum abx
candida and aspergillus
Fever (and other s/s of systemic infection)
hear murmur
CHF
MSK s/s such as back pain
septic emboli
petechiae
splinter hemorrhages
janeway lesions
osler nodes
roth spots
neuro manifestations
What am I?
infective endocarditis
What are splinter hemorrhages caused by?
(linear, red-brown streaks in nail beds) caused by vasculitis or emboli
What is the difference between janeway lesions and osler nodes? What is the MC pathogen for each?
Janeway lesions: (erythematous/hemorrhagic macular or nodular, PAINLESS patches on palms or soles) caused by EMBOLI-> staph is MC
Osler nodes: PAINFUL nodules on pads of fingers or toes) caused by VASCULITIS -> strep is MC
What are roth spots? What is the MC pathogen?
(oval, pale retinal lesions surrounded by hemorrhage) caused by vasculitis
strep
What is the first step in diagnosing endocarditis?
- get a CBC!!!
- draw blood then culture for bacteremia (3 sets of blood cultures from different sites)
- Echo
What type of echo is done in infective endocarditis?
TTE is usually done first because it is quicker to obtain than TEE but TEE is more sensitive and allows to see the vegetation on the valves
**What is the major DUKE criteria?
**What is the minor Duke criteria?
**According to the Duke criteria, what is a definitive infective endocarditis criteria?
2 major criteria, or 1 major and 3 minor, or 5 minor
**According to the Duke criteria, what is the possible infective endocarditis criteria?
1 major and 1 minor, or 3 minor
What are 4 complications of infective endocarditis?
Rupture of the valve tissue or chordal structures, leading to severe valvular regurgitation (i.e. acute AR/MR)
Vegetation may obstruct the valve orifice or create a large embolus (either septic or pulmonary emboli)
Conduction system may be affected by myocardial abscess
Infection may invade the interventricular septum, causing intramyocardial abscesses or septal rupture
What is the abx of choice for native valve infective endocarditis?
Pen G and gentamicin
or
vanc (if MRSA or PCN resistant strep)
What is the abx of choice for IVDU infective endocarditis?
Nafcillin, gentamicin, vancomycin
What is the abx of choice for prosthetic valve infective endocarditis?
Vancomycin, gentamicin, and rifampin
What is the tx of choice for fungal infective endocarditis?
amphotericin B and surgery
What is the sx tx for infective endocarditis?
open sternotomy valve replacement, repair or debridement
What are the sx indications as the tx for infective endocarditis?
CHF refractory to standard medical therapy (most common indication for early surgery)
Fungal IE
Persistent sepsis after 72 hrs of appropriate abx therapy
Recurrent septic emboli, especially after 2 weeks of abx
Rupture of an aneurysm
Conduction disturbances caused by a septal abscess
Kissing infection of the anterior mitral leaflet in patients with IE of the aortic valve
What is another common source besides IVDU for infective endocarditis?
mouth!!! pts need a full dental eval
**What are patient risk factors (groups) that need to be treated prophylactically for infective endocarditis?
Prosthetic heart valves
Prior endocarditis
Cyanotic congenital heart disease (unrepaired, repaired, or partially repaired)
Cardiac transplantation recipients who developed cardiac valvulopathy
**Name 3 procedures that pts would need to be treated prophylactically for infective endocarditis
Dental procedures (or anything that could perforate the oral mucosa)
respiratory tract procedures (tonsils/adenoids)
infected skin or MSK tissue procedures (including draining abscesses)
**What is the abx of choice for endocarditis prophylaxis?
Amoxicillin 2 grams PO 30-60 min prior
