Infective Endocarditis (IE) Flashcards
Vegetations attach to a damaged cardiac structure, circulating microorganisms attach and proliferate,and it becomes a cyst-like structure that defends the colony from defensive cells.
T or F?
T
Acute endocarditis typically involves _______
a. a highly virulent pathogen, typically staphylococcus aureus
b. an invasion of an abnormal valve
c. staphylococcus viridans
d. sudden onset with slow destruction of cardiac tissues
a
IE can be described as _________
a. an infection involving the endothelial layer of the heart
b. an infection involving the epicardial layer of the heart
c. an infection involving the myocardium
d. an infection that only involves the valves
a
Subacute endocarditis typically involves ________
a. invasion of an abnormal valve
b. staphylococcus viridans
c. streptococcus aureus
d. sudden onset
a
The majority of vegs attach to the ______ of the atrioventricular valves and the ______ side of the semilunar valves.
a. atrial/great vessel
b. atrial /ventricular
c. ventricular /atrial
d. ventricular /ventricular
b
The AHA determined that only those with the highest risk of IE should take prophylactic antibiotics prior to dental procedures, to include those with ______
a. cardiac transplant with valvular abnormality
b. history of IE
c. prosthetic heart valve or valve repaired with prosthetic material
d. all of the above
d
Only those with specific congenital anomalies are required to take prophylactic antibiotics prior to reproductive, urinary, or GI procedures. T or F?
F
*Prophylactic antibiotics to prevent IE are NO longer recommended prior to reproductive, urinary, or GI procedure
Only those the highest risk of IE should take prophylactic antibiotics prior to dental procedures including those with:
- prosthetic heart valve
- valve repaired with prosthetic material
- history of IE
- cardiac transplant with a valvular abnormality
- congenital anomalies
- IV drug user
- Marfan syndrome
Patients with IE typically present with symptoms such as fever, run-down feeling, tachycardia, new heart murmur, and negative blood cultures.
T or F?
F
Patients with IE typically present with symptoms such as fever, run-down feeling, tachycardia, new heart murmur, and POSITIVE blood cultures.
The AHA determined that medical and dental procedures are more likely to cause IE than everyday exposure to bacteria.
T or F?
F
Osler’s nodes, petechiae, or similar spots in the whites of the eyes may appear with IE.
T or F?
T
According to the AHA, unrepaired or partially repaired cyanotic lesions, completely repaired defects with prosthetic material ( for the first 6 months post-op),or any repaired defect with a residual defect require prophylactic antibiotics prior to dental procedures.
T or F?
T
The patient is status post MV replacement, and presents with a fever, new holosystolic murmur, chills, and shortness of breath; what is most likely the diagnosis? 、
a probable PVE with MR
b. probable PVE with MS
c. prosthetic valve malfunction
d. ruptured papillary muscle with MR
a
*holosystolic murmur - regurgitant flow
MR: high-pitched holosystolic blowing murmur
A ______ identifies the IE microorganism so the proper antibiotics can be administered.
q. biopsy
ъ, blood culture
c. TEE
d. TTE
b
A l6-year old presents with a history of MVP, a large mobile yeg attached to the AMVL, severe MR, abscess of the MV annulus, and positive blood cultures; a few days later, she develops acute altered mental status: what is most likely the diagnosis?
a. infection in her brain caused sepsis and embolization to heart
b. MV veg with embolization to the brain
c. ruptured AMVL with decreased CO
d. there is no relation between the MV and her mental status
b
An abscess often presents as an echo-free cavity in the annulus of the infected valve or an echo-density in an adjacent structure.
T or F?
T
Once diagnosed with IE, antibiotics may be required for up to 6 weeks, surgical repair/replacement of valve may be indicated, and prophylactic antibiotics will be prescribed for future procedures.
T or F?
T
IE has a low association with morbidity and mortality due to low antimicrobial resistance and ease of treatment.
T or F?
F
A 37-year old soccer player who is status post sinus infection presents with a new systolic crescendo decrescendo murmur, chills, dizziness, and says that he can no longer keep up on the field; what is most likely his diagnosis?
a. AR due to AOV veg
b. AS due to AOV veg
c. AS/AR due to rheumatic heart disease
d. degenerative AS/AR
b
*systolic crescendo-decrescendo murmur = stenotic flow
AS: low pitched systolic crescendo-decrescendo murmur
Vegs that are>5 mm, mobile, and pedunculated have a decreased risk of embolization.
T or F?
F
Vegs that are>5 mm, mobile, and pedunculated have a increased risk of embolization.
IE structural and hemodynamic changes that occur to the valve and/or cardiac structures include regurgitation, stenosis, flail leaflets, intracardiac fistula, and prosthetic valve dehiscence.
T or F?
T
A 25-year old patient with a history of IV drug abuse presents with fever, chills, fatigue, chest pain, and a new holosystolic murmur: veg is not detected by echo; therefore, one can assume that the patient does not have IE.
T or F?
F
*veg must be >2-3mm to be seen by TTE
TEE is much more sensitive and usually detects veges >1mm in size
REMEMBER: the absence of a veg by echo does not rule out the diagnosis of IE
Which of the following best describes a veg?
a. shaggy, swinging, or pedunculated
b. must be>1 mm to be seen by TTE
c. must be>3 mm to be seen by TEE
d. all of the above
a
An AOV veg with severe, acute AR is diagnosed; what else might be detected on echo?
a. AMVL flutter
b. dilated LV with hyperdynamic LVFX
c. M-mode oscillations in the LVOT
d. all of the above
d
If a veg is detected, the sonographer should _________
a. assess the size of the veg with planimetry and/or calipers
b. acquire M-mode, CFD & spectral Doppler to assess the function of the valve
c. provide multiple windows and views of the veg
d. All of the above
d
