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Cardiovascular (Annie) > Infective endocarditis & other cardiac infections > Flashcards

Infective endocarditis & other cardiac infections Flashcards

1
Q

what is a blood culture normally?

A

sterile

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2
Q

what is a potentially life-threatening situation that can occur in the bloodstream?

i.e. what is meant by bacteraemia?

what happens if this life threatening situation is NOT treated promptly?

A
  • presence of bacteria in bloodstream (bacteraemia or septicaemia)

= presence of bacteria in the bloodstream

= patient may develop septic shock and die

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3
Q

what 3 question should you ask yourself if there is a positive culture?

A

1) What is the usual HABITAT of the organism?
2) what DISEASES is this organism associated with?
3) what is the optimum ANTIMICROBIAL management required?

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4
Q

what is infective endocarditis?

A

= infection of endothelium of the heart valves which is life threatening

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5
Q

what are the 2 types infective endocarditis can be?

A

1) acute

2) sub-acute

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6
Q

what are 4 predisposing factors for infective endocarditis?

A

1) heart valve abnormality
2) prosthetic heart valve
3) Intra-venous drug users
4) intra-vascular lines

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7
Q

what are 3 possible heart valve abnormalities that could act as predisposing factors for infective endocarditis?

A

1) calcification/sclerosis in elderly
2) congenital heart disease
3) post rheumatic fever

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8
Q

what pathological change happens to the heart valves in infective endocarditis?

A

= heart valves are damaged

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9
Q

what happens to blood flow in infective endocarditis?

A

= turbulent blood flow over roughed endothelium

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10
Q

what is pathologically deposited in infective endocarditis?

A

= platelets/fibrin is deposited

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11
Q

what pathological thing might happen in the blood stream in infective endocarditis?

A

= bacteraemia (may be very transient)

e.g. from dental treatment

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12
Q

where does the bacteria organisms in infective endocarditis settle and thus what do they become?

A
  • organism settle in fibrin/platelet thrombi

BECOMING
= a microbial vegetation

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13
Q

what can happen to the infected vegetations when they become friable and break off in infective endocarditis?

A

= they break off
= becoming lodged in next capillary bed they encounter
= causing abscesses or haemorrhage
- may be fatal

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14
Q

what side of the heart is usually affected?

and thus what 2 valves are most usually affected?

A

= left side of heart

= mitral and aortic valves

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15
Q

what are the 4 organisms causing endocarditis native valve?

from most common to least

A

1) staphylococcus aureus
2) viridan’s streptococci
3) enterococcus sp
4) staph epidermidis

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16
Q

what are 3 branches of unusual organisms causing endocarditis?

A

1) atypical organisms
2) gram-negatives
3) fungi

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17
Q

give examples of atypical organisms that are unusual organisms in causing endocarditis?

A
  • bartonella
  • coxiella burnetii
  • chlamydia
  • legionella
  • mycoplasma
  • brucella
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18
Q

give examples of gram negative organisms that are unusual organisms in causing endocarditis?

A

1) HACEK organisms
- haemophilus spp
- aggregatibacter spp
- cardiobacteriium
- eikenella sp
- kingella sp.

2) non-HACEK

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19
Q

what is the major criteria required to diagnose infective endocarditis?

A

1) 2 separate positive blood cultures with microorganisms typical for infective endocarditis: viridans, streptococci, streptococcus bovid, HACEK group, staphylococcus aureus

2) echocardiogram of endocardial involvement
- typical valvular lesions: vegetation, abscess or new partial dehiscence of prosthetic valve

3) new valvular regurgitation

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20
Q

what is the minor criteria for diagnosing infective endocarditis?

A

1) predisposition heart conditions or IV drug user
2) temperature greater than 38degrees
3) vascular phenomenon
4) immunological phenomenon
5) microbiological evidence: positive blood culture but not meeting major criteria

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21
Q

what is the gram positive cocci in clusters called?

A

= staph

22
Q

what is the most common coagulase-negative staphylococcus?

A

staphylococcus epidermidis

23
Q

how do you most commonly get the bacteria staphylococcus epidermidis?

A
  • skin contaminants
    BUT
  • can infect prothetic material e.g. intra-vascular line infections, prosthetic heart valves
24
Q

what is an example of another skin contaminate?

A

= corynebacterium sp

25
Q

what are the presenting symptoms of acute endocarditis?

A

= overwhelming sepsis

= cardiac failure

26
Q

what is the presenting symptoms of acute endocarditis usually due to?

A

= staphylococcus aureus

27
Q

what are the presenting symptoms and signs of sub-acute endocarditis?

A

SYMPTOMS:

  • fever
  • malaise
  • weight loss
  • tiredness
  • breathlessness

SIGNS:

  • fever
  • new or changing heart murmur
  • finger clubbing
  • splinter haemorrhages
  • splenomegaly
  • Roth spots (retinal haemorrhages), Osler nodes, (painful red lesions on palms and soles), janeway lesions (hodular haemorrhagic lesions on palms and soles)
  • microscopic haematuria
28
Q

what type of streptococci makes up viridans group streptococci and give examples?

A

= alpha haemolytic strep

  • strep. mitis
  • strep. sanguinis
  • strep. mutans
  • strep. salivarius
29
Q

what 2 important things should you be aware of in sub-acute endocarditis?

A
  • normal oral commensals
  • no lance field groups
    e. g. no catalase negative bacteria
30
Q

what 2 types of prosthetic valve endocarditis can you present with?

A

1) early

2) later

31
Q

when does early prosthetic valve endocarditis usually occur?
and
what organisms usually cause prosthetic valve endocarditis?

A

= usually infected at time of valve insertion

  • staphylococcus epidermidis
  • staphylococcus aureus
32
Q

when does late prosthetic valve endocarditis usually occur?
and
what causes prosthetic valve endocarditis?

A

= many years after valve insertion

  • duet to co-incidental bacteraemia
    = wide range of possible organisms
33
Q

what side of the heart are people who inject drugs (PWID) usually most likely to develop endocarditis?

A

= right side of heart (tricuspid&raquo_space; mitral > aortic)

34
Q

what organism usually causes endocarditis in PWID?

A

= staphylococcus aureus

35
Q

how would you treat native valve endocarditis caused by viridans strep?

A
  • amoxicillin
    &
  • gentamicin IV
36
Q

how would you treat prosthetic valve endocarditis?

A
  • vancomycin & gentamicin IV
  • add in 3 to 5 (delayed) rifampicin PO
  • often valve replacement required
37
Q

how would you treat drugs users endocarditis (MSSA)?

A
  • flucloxacillin IV
38
Q

how would you specifically treat staphylococcus aureus (not MSSA)?

A

= flucloxacillin IV

39
Q

how would you specifically treat viridans streptococci?

A

= Benzylpenicillin iv & gentamicin iv (synergistic)

40
Q

how would you specifically treat enterococcus sp?

A

= Amoxicillin/ vancomycin & gentamicin IV

41
Q

how would you specifically treat staphylococcus epidermidis?

A

= Vancomycin & gentamicin IV & rifampicin PO

42
Q

what monitoring therapy should be done?

A
  • IV antibiotics usually given for 4-6weeks
  • monitor cardiac function, temperature and serum C reactive protein (CRP)
  • if failing an antibiotic therapy, consider referral for surgery early
43
Q

in what type of people is myocarditis most commonly seen?

A

= in young people (causing sudden death)

44
Q

what are the symptoms and signs of myocarditis?

A

Symptoms

  • fever
  • chest pain
  • shortness of breath
  • palpitations

Signs

  • arrhythmia
  • cardiac failure
45
Q

what is myocarditis mainly caused by?

A

= enteroviruses

e. g.
- coxsackie A & B
- echovirus

46
Q

how do you diagnose myocarditis?

A

= viral PCR

- throat swab for influenza and stool for enteroviruses

47
Q

what often occurs along side myocarditis?

A

= pericarditis

48
Q

what is the main feature of pericarditis?

A

= chest pain

49
Q

what is the main cause of pericarditis?

A

= viral mainly

  • bacteria less common
    e. g. post cardiothoracic surgery, rarely secondary spread from endocarditis or pneumonia treatment
50
Q

how would you treat pericarditis?

A
  • antibiotics

- drainage

51
Q

give examples of some causes of pericardial diseases?

A

1) viral
- coxsackievirus, echovirus, adenovirus, EBV, CMV, influenza, varicella, rubella, HIV, hepatits, B mumps

2) bacterial
- staphylococcus
- streptococcus
- pneumococcus
- haemophilus
- neisseria
- chlamydia
- legionella
- tuberculosis
- salmonella
- lyme disease

3) mycoplasma

4) fungal
- asperigillosis
- blastomycosis

5) parasitic
6) infective endocarditis with valve ring abscess

Cardiovascular (Annie) (36 decks)

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