Infective Endocarditis - Krause

Question 1

Structures affected by IE

Answer 1

Endocardium (inner lining)
Chordae Tendinae
Valves

Question 2

Risk factors for IE

Answer 2

*IV drug ause
*Chronic invasion of the skin (indwelling cath)
Poor dental hygeine
DM
Prosthetic valves

Question 3

Organisms commonly causing IE

Answer 3

Staph aureus (slow clearing)
S. epidermidis (early prosthetic valve IE)
Strep (mutans, sanguis)
Strep Bovis (elderly, needs colonoscopy)

Question 4

Other IE organisms

Answer 4

HACEK
Haem.
Actinobacillus
Cardiobacterium hominis
Eikenella
Kingella kingae
(others = Enterococci, Fungi, coxiella)

Question 5

Signs and Symptoms

Answer 5

Fever, wt. loss, fatigue, night sweats

Heart failure, heart murmur

Splenomegaly, skin petechiae

Osler/Janeway/Roth

Splinter and conjunctival hemorrhages

Question 6

Biggest Sx for IE

Answer 6

Fever and murmur (louder)

Question 7

Oslers nodes

Answer 7

Painful Subq nodules on the pulp of fingers and toes

Vasulitis due to immune mediated complexes

Question 8

Janeway lesions

Answer 8

Non-tender
Palms and soles of feet
variable size and shape
Days to weeks

Question 9

Which lesion is positive for culture

Answer 9

Janeway lesions

Question 10

Histology of oslers and janeway

Answer 10

Janeway = septic microemboli
Osler = Vasculitis

Question 11

Three things Perivalvular abscess causes

Answer 11

Valve dysfunction
Heart block
Stroke

Question 12

Usually dont look for ____ in IE

Answer 12

EKG changes

unless heart block but this is late finding

Question 13

Dx of IE

Answer 13

Modified Dukes criteria

2 Major
1 Major + 3 Minor
5 Minor

Question 14

Major criteria for IE

Answer 14

Lab evidence (2+ blood cultures, 1+ blood culture coxiella)

Endocardial involvement (TTE, TEE)

New Valvular regurgitataion

Question 15

Minor criteria

Answer 15

Predisposing heart condition

Fever

Vascular Phenomenon (Emboli (Janeway), mycotic, aneurysm, hemorrhages)

Immunologic Phenom. (GN, Osler node, Rh factor)

Positive blood culture (but not one of the primary organisms for IE)

Question 16

Treatment of IE

Answer 16

2-6 weeks IVAB

(Gram positive – Penicillin sensitive?)

YES = Pen or  Amp PLUS aminoglycoside
NO = Vanc + aminoglycoside

Question 17

____ is not indicated in IE treatment

Answer 17

Anticoagulation

doesnt prevent embolism, may increase risk of bleeding

Question 18

Symptoms of Carcinoid syndrome

Answer 18

Flushing + diarrhea

Question 19

Can’t have pericarditis without ______

Answer 19

Chest pain

Question 20

Best first test for IE

Answer 20

Blood cultures

Question 21

____ Echo first in native valve endocarditis

____ Echo first in prosthetic valve endocarditis

Answer 21

TTE

TEE

Question 22

Indications for prophyaxis

Answer 22

• Prosthetic valve
• Heart transplant recipient
• PREVIOUS ENDOCARDITIS
• uncorrected cyanotic heart disease

(PLUS, dental work with bleeding, tonsilectomy)

Question 23

Add ___ if prosthetic valve

Answer 23

rifampin