Infective Endocarditis - Exam 1

Question 1

Define infective endocarditis. What are 3 common sources? Is left or right sided more common?

Answer 1

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

Question 2

What are the risk factors for infective endocarditis?

Answer 2

previous endocarditis
prosthetic valve or pacemaker
valvular/congenital heart disease
IVDU
intravenous catheter
immunosuppression
recent dental/surgical procedure

Question 3

**______ is the most common pathogen that effects native valves. What is 2nd MC?

Answer 3

Stap- MC

Strep- 2nd MC

Question 4

infective endocarditis for prosthetic valves that occur within the first TWO MONTHS is ______. After the initial window it is ______

Answer 4

early- Staph

late- strep

Question 5

What is the MC pathogen for infective endocarditis for IVDU? What is the MC valve effect for IVDU?

Answer 5

Staph- MC

then strep and enterococci

tricuspid valve

Question 6

_____ is the MC pathogen for infective endocarditis due to nosocomial infections

Answer 6

staph aureus

Question 7

What are the most common types of pts who have fungal infective endocarditis? What are the two most common fungi?

Answer 7

IVDU and pts who receive broad spectrum abx

candida and aspergillus

Question 8

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?

Answer 8

infective endocarditis

Question 9

What are splinter hemorrhages caused by?

Answer 9

(linear, red-brown streaks in nail beds) caused by vasculitis or emboli

Question 10

What is the difference between janeway lesions and osler nodes? What is the MC pathogen for each?

Answer 10

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

Question 11

What are roth spots? What is the MC pathogen?

Answer 11

(oval, pale retinal lesions surrounded by hemorrhage) caused by vasculitis

strep

Question 12

What is the first step in diagnosing endocarditis?

Answer 12

1. get a CBC!!!
2. draw blood then culture for bacteremia (3 sets of blood cultures from different sites)
3. Echo

Question 13

What type of echo is done in infective endocarditis?

Answer 13

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

Question 14

**What is the major DUKE criteria?

Answer 14

Question 15

**What is the minor Duke criteria?

Answer 15

Question 16

**According to the Duke criteria, what is a definitive infective endocarditis criteria?

Answer 16

2 major criteria, or 1 major and 3 minor, or 5 minor

Question 17

**According to the Duke criteria, what is the possible infective endocarditis criteria?

Answer 17

1 major and 1 minor, or 3 minor

Question 18

What are 4 complications of infective endocarditis?

Answer 18

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

Question 19

What is the abx of choice for native valve infective endocarditis?

Answer 19

Pen G and gentamicin

or

vanc (if MRSA or PCN resistant strep)

Question 20

What is the abx of choice for IVDU infective endocarditis?

Answer 20

Nafcillin, gentamicin, vancomycin

Question 21

What is the abx of choice for prosthetic valve infective endocarditis?

Answer 21

Vancomycin, gentamicin, and rifampin

Question 22

What is the tx of choice for fungal infective endocarditis?

Answer 22

amphotericin B and surgery

Question 23

What is the sx tx for infective endocarditis?

Answer 23

open sternotomy valve replacement, repair or debridement

Question 24

What are the sx indications as the tx for infective endocarditis?

Answer 24

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

Question 25

What is another common source besides IVDU for infective endocarditis?

Answer 25

mouth!!! pts need a full dental eval

Question 26

**What are patient risk factors (groups) that need to be treated prophylactically for infective endocarditis?

Answer 26

Prosthetic heart valves

Prior endocarditis

Cyanotic congenital heart disease (unrepaired, repaired, or partially repaired)

Cardiac transplantation recipients who developed cardiac valvulopathy

Question 27

**Name 3 procedures that pts would need to be treated prophylactically for infective endocarditis

Answer 27

Dental procedures (or anything that could perforate the oral mucosa)

respiratory tract procedures (tonsils/adenoids)

infected skin or MSK tissue procedures (including draining abscesses)

Question 28

**What is the abx of choice for endocarditis prophylaxis?

Answer 28

Amoxicillin 2 grams PO 30-60 min prior