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Infective Endocarditis & other infections Flashcards

1
Q

What does FROM JANE stand for? and what does it help you remember?

A

It is a list of common/buzzword symptoms for endocarditis

Fever
Roth’s spots
Osler’s nodes
Murmur

Janeway lesions
Anaemia
Nail haemorrhages
Emboli

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2
Q

Common symptoms of acute infective endocarditis

A

Sepsis

Cardiac failure

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3
Q

Common symptoms of subacute infective endocarditis (not including FROM JANE)

A

Malaise, weight loss, tiredness, SOB.

General symptoms of infection.

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4
Q

What are Osler’s nodes?

A

Painful red nodules on the hands and feet

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5
Q

What are Roth’s spots?

A

Retinal haemorrhages

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6
Q

What are Janeway lesions?

A

Non-painful nodules on hands and feet

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7
Q

What investigations must be done?

A

Minimum of 3 blood cultures

Echo

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8
Q

What is used for diagnosis?

A

Duke’s criteria

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9
Q

When is Duke’s criteria used? and what is it?

A

Used to diagnose infective endocarditis

Infective endocarditis can be diagnosed if 2major or 5 minor criteria are reached

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10
Q

What are the major criteria from Duke’s criteria?

A

2 x positive blood culture
Echo evidence
New valve regurgitation

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11
Q

What are the minor criteria from Duke’s criteria?

A 
Temp >38
Heart condition
IVDU
Vascular phenomena
Immunological phenomena
Microbiological evidence (blood culture?)
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12
Q

What are vascular phenomena

A

Emboli

Janeway lesions

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13
Q

What are immunological phenomena

A

Roth’s spots

Osler’s nodes

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14
Q

Risk factors

A 
Heart valve abnormality
Old age (valve calcification)
Congenital Heart Disease
Rheumatic fever
IVDU
Prosthetic valve
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15
Q

What bacteria causes endocarditis in IVDU

A

Staph. aureus

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16
Q

What valve is most commonly affected?

A

tricuspid

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17
Q

What side of the heart is affected in IVDU

A

Right

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18
Q

Atypical causes of endocarditis

A

Coxiella bunetti
Brucella
Gram -ve
Fungi

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19
Q

Empirical treatment of a native valve

A

IV Amoxicillin + IV gentomycin

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20
Q

Empirical treatment of prosthetic valve

A

IV vancomycin + IV gentomycin

add Rifampicin on days 3-5, PO

21
Q

Treatment of staph. aureus

A

Flucloxillin

22
Q

Treatment usually required by IVDU

A

Flucloxillin

23
Q

Treatment of MRSA

A

IV vancomycin + IV gentomycin

add Rifampicin on days 3-5, PO

24
Q

Treatment of Strep. viridans

A

IV Benzylpenicillin + IV gentomycin

25
Treatment of Strep. epidermis
IV vancomycin + IV gentomycin | add Rifampicin on days 3-5, PO
26
Pathophysiology of Myocarditis
Acute inflammation of the myocardium. Heart becomes "flabby" focal haemorrhages and inflammatory infiltrate
27
"Flabby" heart
Myocarditis
28
Focal haemorrhages
Myocarditis
29
symptoms of Myocarditis
palpitations/ arrhymias Heart failure Chest pain Fatigue (general symptoms of infection)
30
Investigations of Myocarditis
1st - viral PCR (throat & stool swab) ECG = ST abnormality CXR
31
CXR showing cardiac enlargement
Myocarditis
32
CXR of Myocarditis
cardiac enlargement
33
ECG of Myocarditis
ST abnormality
34
ECG showing ST abnormality
Myocarditis
35
Treatment of Myocarditis
supportive | ACEI, Beta-blockers, spironolactone,digoxin (rarely given)
36
What often occurs with Myocarditis?
Pericarditis
37
Symptoms of Pericarditis
chest pain which is relived by sitting forward, SOB
38
Chest pain which is relived by sitting forward
Pericarditis
39
Treatment of Pericarditis
supportive | drainage + antibiotics
40
Main cause of myocarditis
viral
41
What is dressler's syndrome?
Pericarditis 4-6 weeks post MI
42
When does Pericarditis often occur?
post-op
43
Secondary spread of endocarditis and pneumonia causes what?
Pericarditis
44
Secondary spread of what can cause Pericarditis?
Endocarditis | Pneumonia
45
Saddle-shaped ST elevation
Pericarditis
46
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
47
most common organism that causes endocarditis
staph.aureus
48
dental surgery is linked to which endocarditis causing pathogen
strep.viridians
49
endocarditis after dental surgery would be treated with what
Benzylpenicillin IV & Gentamycin IV

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