Infective Endocarditis Lecture Powerpoint Flashcards
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Infective endocarditis
Infection of the hearts endocardial surface, most commonly involving the valves but may also occur at a septal defect or chordae tendinae, can be acute or subacute
Risk factors associated with infective endocarditis (5)
- underlying cardiac structural abnormalities
- pacemaker infections
- prolonged surgery
- catheter related bacteremia
- IV drug abuse or piercings
Infective endocarditis factors affecting mortality (4)
- Virulence and health of patient
- Embolism of bacteria
- Immunocompromised patient
- If left untreated, uniformly fatal
3 big presenting signs and symptoms of endocarditis
- fever
- onset of new murmur
- positive blood cultures
Microorganisms associated with native valve endocarditis (3)
- S aureus (skin, iv drug use)
- viridans group streptococci (most common)
- HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella: uncommon, seen in immunocompromised hosts)
Microorganisms associated with prosthetic valve endocarditis (3)
- coag neg staphylococci
- fungi
- staphylococci (from defibrillator/pacemaker)
Signs of embolization of vegetation from infective endocarditis in periphery (4)
- pectechiae (small hemorrhages sometimes in nailbeds [called splinter hemorrhages])
- osler’s node (painful, purple lesions on fingers and toes)
- janeway lesions (flat, painless red lesions on palms and soles)
- roth spots (retinal hemorrhages with pale or yellow centers)
Modified Duke Criteria
Clinical criteria for diagnosing infective endocarditis requiring a combo of major and minor criteria
Lab findings indicative of infective endocarditis (5)
- anemia (normocytic, normochromatic)
- hypergammaglobulinemia
- leukocytosis
- RBC casts
- Pos blood culture**
Blood culturing process for infective endocarditis
- 3 sets drawn at least 1 hour apart for 3 diff mediums (aerobic, anaerobic, fungal)
- as soon as positive is obtained then starting broad spectrum antibiotic treatment
- narrow down once culture and sensitivity obtained
IV drug users will see growth of vegetation mostly on ____ sided valves
Right
Transthoracic echocardiogram should always precede a ____ one
transesophageal
Valvular dehiscence
Refers to the separating of an artificial valve from its anchor due to vegetation overgrowth resulting in rocking motion of prosthetic valve back and forth with blood flow
Infective endocarditis treatment (2)
Hospitalization and IV antibiotics:
- PCN and gentamycin IV daily for 4 weeks (most common)
- vanco or ceftriaxone IV daily 4 weeks
Indications for surgery to treat native valve endocarditis (4)
- acute mitral or aortic regurg with heart failure
- fungal endocarditis
- evidence of aortic abscess
- valve dysfunction and persistent infection after 7-10 days of antibiotic treatment
Indications for surgery to treat prosthetic valve endocarditis (4)
- early prosthetic valve endocarditis (first 2 months after surgery)
- fungal endocarditis
- evidence of paravalvular leak or aortic abscess
- vegetation of any size on or near the prosthesis
Optimal duration of antibiotic therapy after surgery for treatment of infective endocarditis
unknown exactly, but at least weeks to months
5 year mortality of infective endocarditis
54-87%
Procedures that put patients at elevated risk of infective endocarditis and which is most common? (5)
- endoscopy
- colonoscopy
- dental extractions
- TURP (most common)
- transesophageal echocardiography
Antibiotic prophylaxis for infective endocarditis (2)
- amoxicillin 2 g 1 hr prior to procedure***
- clindamycin 600mg if allergic
Who get infective endocarditis prophylaxis? (4)
- all patients with prosthetic heart valves or other mechanical part of heart
- all patients with pmh of endocarditis
- patients with complex congenital heart disease including palliative shunts
- all patients with left sided valvular heart disease
Infective endocarditis complications (3)
- Stroke
- Embolization
- vegetative damage to leaflets of valve
