Infective Endocarditis & other infections Flashcards
What does FROM JANE stand for? and what does it help you remember?
It is a list of common/buzzword symptoms for endocarditis
Fever
Roth’s spots
Osler’s nodes
Murmur
Janeway lesions
Anaemia
Nail haemorrhages
Emboli
Common symptoms of acute infective endocarditis
Sepsis
Cardiac failure
Common symptoms of subacute infective endocarditis (not including FROM JANE)
Malaise, weight loss, tiredness, SOB.
General symptoms of infection.
What are Osler’s nodes?
Painful red nodules on the hands and feet
What are Roth’s spots?
Retinal haemorrhages
What are Janeway lesions?
Non-painful nodules on hands and feet
What investigations must be done?
Minimum of 3 blood cultures
Echo
What is used for diagnosis?
Duke’s criteria
When is Duke’s criteria used? and what is it?
Used to diagnose infective endocarditis
Infective endocarditis can be diagnosed if 2major or 5 minor criteria are reached
What are the major criteria from Duke’s criteria?
2 x positive blood culture
Echo evidence
New valve regurgitation
What are the minor criteria from Duke’s criteria?
Temp >38 Heart condition IVDU Vascular phenomena Immunological phenomena Microbiological evidence (blood culture?)
What are vascular phenomena
Emboli
Janeway lesions
What are immunological phenomena
Roth’s spots
Osler’s nodes
Risk factors
Heart valve abnormality Old age (valve calcification) Congenital Heart Disease Rheumatic fever IVDU Prosthetic valve
What bacteria causes endocarditis in IVDU
Staph. aureus
What valve is most commonly affected?
tricuspid
What side of the heart is affected in IVDU
Right
Atypical causes of endocarditis
Coxiella bunetti
Brucella
Gram -ve
Fungi
Empirical treatment of a native valve
IV Amoxicillin + IV gentomycin
Empirical treatment of prosthetic valve
IV vancomycin + IV gentomycin
add Rifampicin on days 3-5, PO
Treatment of staph. aureus
Flucloxillin
Treatment usually required by IVDU
Flucloxillin
Treatment of MRSA
IV vancomycin + IV gentomycin
add Rifampicin on days 3-5, PO
Treatment of Strep. viridans
IV Benzylpenicillin + IV gentomycin
Treatment of Strep. epidermis
IV vancomycin + IV gentomycin
add Rifampicin on days 3-5, PO
Pathophysiology of Myocarditis
Acute inflammation of the myocardium. Heart becomes “flabby” focal haemorrhages and inflammatory infiltrate
“Flabby” heart
Myocarditis
Focal haemorrhages
Myocarditis
symptoms of Myocarditis
palpitations/ arrhymias
Heart failure
Chest pain
Fatigue (general symptoms of infection)
Investigations of Myocarditis
1st - viral PCR (throat & stool swab)
ECG = ST abnormality
CXR
CXR showing cardiac enlargement
Myocarditis
CXR of Myocarditis
cardiac enlargement
ECG of Myocarditis
ST abnormality
ECG showing ST abnormality
Myocarditis
Treatment of Myocarditis
supportive
ACEI, Beta-blockers, spironolactone,digoxin (rarely given)
What often occurs with Myocarditis?
Pericarditis
Symptoms of Pericarditis
chest pain which is relived by sitting forward, SOB
Chest pain which is relived by sitting forward
Pericarditis
Treatment of Pericarditis
supportive
drainage + antibiotics
Main cause of myocarditis
viral
What is dressler’s syndrome?
Pericarditis 4-6 weeks post MI
When does Pericarditis often occur?
post-op
Secondary spread of endocarditis and pneumonia causes what?
Pericarditis
Secondary spread of what can cause Pericarditis?
Endocarditis
Pneumonia
Saddle-shaped ST elevation
Pericarditis
pathogenesis of endocarditis
heart valve is damaged causing turbulent blood flow over roughened endothelium. platelets/fibrin is deposited. organisms settle in the fibrin/platelet thrombi forming microbial vegetation
most common organism that causes endocarditis
staph.aureus
dental surgery is linked to which endocarditis causing pathogen
strep.viridians
endocarditis after dental surgery would be treated with what
Benzylpenicillin IV & Gentamycin IV
