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Cardiovascular System > Infective Endocarditis - Presentation, Investigation & Therapy > Flashcards

Infective Endocarditis - Presentation, Investigation & Therapy Flashcards

1
Q

What is infective endocarditis?

A

Infection of the endocardium

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2
Q

What is infection of the endocardium called?

A

Infective endocarditis

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3
Q

What are the 3 layers of the heart?

A

Epicardium

Myocardium

Endocardium

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4
Q

In what layer are the valve structures?

A

Endocardium

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5
Q

In what layer are the chordae tendinae?

A

Endocardium

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6
Q

What is the mortality of infective endocarditis?

A

High (15-30%)

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7
Q

What is the prevalence of infective endocarditis?

A

3-10/100000

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8
Q

What is the male to female ratio of infective endocarditis?

A

Male to female 2:1

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9
Q

Does infective endocarditis affect more males or females?

A

Males

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10
Q

Is the prognosis of infective endocarditis worse in males or females?

A

Females

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11
Q

How is the team that treats infective endocarditis pretty unique?

A

It has its own team

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12
Q

What is the team that treats infective endocarditis called?

A

IE team

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13
Q

Who is in the IE team?

A

Cardiologist

Microbiologist

Cardiothoracic surgeon

Neurologist/neurosurgeons

Reference centre

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14
Q

What is the advantage of infective endocarditis having its own team?

A

Reduces mortality

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15
Q

Who are some typical people who present with infective endocarditis?

A

Older patients with degenerative heart disease

Healthcare

Intra cardiac devices (ICD)

Valve diseases

Prosthetic valves

Immunocompromised patients

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16
Q

What does ICD stand for?

A

Intra-cardiac devices

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17
Q

What are some diseases that lead to infective endocarditis?

A

Native valve infective endocarditis

Mitral valve prolapse

Congenital heart disease

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18
Q

What are examples of congenital conditions that can lead to infective endocarditis?

A

Ventricular septal defect

Bicuspid aortic valve

Patent ductus arteriosus

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19
Q

What are some risk factors for native valve infective endocarditis?

A

Mitral valve disease

Rheumatic heart disease

Congeital heart disease

Degenerative heart disease

Asymmetrical septal hypertrophy

Intravenous drug abusers

Alcoholic cirrhosis

Diabetic mellitus

Indwelling medical devices

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20
Q

What is the pathophysiology for infective endocarditis?

A

1) Normal valve endothelium is resistance to colonisation and infection
2) Mechanical endothelial disruption exposes extracellular matrix protein causing production of tissue factors
3) Deposition of fibrin and platelets causing nonbacterial thrombotic endocarditis
4) This facilitates bacterial adherence and infection

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21
Q

What is normal valve endothelium resistant to?

A

Colonisation and infection

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22
Q

What does a damaged endothelial valve lead to?

A

Turbulent blood flow

Electrodes

Catheters

Inflammation (rheumatic carditis)

Degenerative valve disease

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23
Q

As well as damaged endothelial valve, how may a normal valve lead to infective endocarditis?

A

Inflammation

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24
Q

What are the different ways a normal valve can lead to infective endocarditis?

A

Damaged endothelium

Inflammation

Bacteraemia

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25
Q

What is the process of a valve becoming inflammed and leading to infective endocarditis?

A

1) Inflammation of endothelial cell causes expression of integrins
2) Integrins are transmembrane proteins that bind to circulating fibronectin
3) Staph aureus (and other pathogens) carry fibronectin which binds to these surface proteins
4) Aherent organisms trigger active internalisation into valve endothelial cells

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26
Q

What are integrins?

A

Transmembranous proteins that bind to circulating fibronectin

27
Q

What is bacteraemia?

A

Bacteria in the blood

28
Q

What is bacteria in the blood called?

A

Bacteraemia

29
Q

What does bacteraemia occur due to?

A

Invasive procedures

Extra-cardiac infections

Non-invasive activites

30
Q

What are some examples of invasive procedures that can lead to bacteraemia?

A

Dental procedures

GU and GI surgery

Intravascular catheters

31
Q

What are some examples of non-invasive activities that can lead to bacteraemia?

A

Chewing

Tooth brushing

32
Q

What are some examples of organisms that can cause infective endocarditis?

A

Virdans group streptococci

Staphylococcus aureus

Enterococci

Coagulase negative staphylococci

Fungi

33
Q

What are the different classifications of infective endocarditis?

A

Acute (days/week) to subacute (weeks to months)

Nidus (localisation) of infection with/without intra-cardiac material

Mode of acquisition (IVDU, healthcare or community)

Acute infective endocarditis

Recurrent (relapse or reinfection)

34
Q

How is infective endocarditis not a constant disease?

A

Syndrome diagnosis determined by presence of multiple findings

Presence or absence of pre-existing cardiac disease

Different causative organisms

Presence or absence of complication

Underlying patient characteristics

35
Q

What is seen for the diagnosis of infective endocarditis?

A

High index of suspicion needed given variable presentation

Bacteraemia with audible murmur should raise suspicion

Classic new or worsening cardiac murmur is rare

Atypical presentation in elderly or immunocompromised

Acutely or subacutely

36
Q

What is the presentation of infective endocarditis like in the elderly and immunocompromised?

A

Atypical

37
Q

What are some common symptoms of infective endocarditis?

A

Fever

Nigh sweats

Malaise

Fatigue

Anorexia

Weight loss

Weakness

Arthralgia

Headache

Shortness of breath

38
Q

What are some clinical signs of infective endocarditis?

A

Cardiac murmur

Janeway lesions

Osler nodes

Roth spot

Splinter haemorrhage

39
Q

What are janeway lesions?

A

Haemorrhagic, macular, painless plaques with predilection for palms and soles

40
Q

What are haemorrhagic, macular, painless plaques with predilection for palms and soles called?

A

Janeway lesions

41
Q

What are osler nodes?

A

Small, painful nodular lesion found on pads of fingers or toes

42
Q

What are small, painful nodular lesion found on pads of fingers or toes?

A

Osler nodes

43
Q

What is a splinter haemorrhage?

A

Tiny blood clots that run vertically under the nails

44
Q

What are tiny blood clots that run vertically under the nails?

A

Splinter haemorrhage

45
Q

What investigations are done for infective endocarditis?

A

Blood culture

Blood tests

Urinalysis

ECG

Chest X-ray

Echocardiogram

46
Q

Why is a blood test done for infective endocarditis?

A

Look for elevated acute inflammatory markers

47
Q

Why is urinalysis done for infective endocarditis?

A

Test for blood

48
Q

Why is a chest X-ray done for infective endocarditis?

A

Look for pulmonary congestion or abscess

49
Q

What is the major criteria for the diagnosis to be infective endocarditis?

A

Blood culture positive (typical microorganism with 2 blood cultures)

Image positive

50
Q

What is minor criteria for the diagnosis to be infective endocarditis?

A

Predisposition such as previous heart condition or injection drug use

Fever (temperature > 38)

Vascular phenomena

Immunological phenomena

Microbiological evidence (does not meet major criteria)

51
Q

What criteria is required for the diagnosis of infective endocarditis to be definite?

A

2 major

1 major and 3 minor

5 minor

52
Q

What criteria is required for the diagnosis of infective endocarditis to be possible?

A

1 major and 1 minor

3 minor

53
Q

What criteria is required for the diagnosis of infective endocarditis to be rejected?

A

Resolution of endocarditis syndrome with antibiotic therapy for less than or 4 days

54
Q

When should IV antibiotics be initiated for infective endocarditis?

A

3 sets of blood cultures (taken 30 mins apart) are positive

55
Q

What is the treatment of infective endocarditis?

A

IV antibiotics

56
Q

When does the type of antibiotics used for infective endocarditis change?

A

Depends on the classification of infective endocarditis

57
Q

What are examples of different classifications of infective endocarditis?

A

Community acquired infective endocarditis

Early PVE (<12 months post surgery) infective endocarditis

Healthcare associated infective endocarditis

58
Q

What antibiotics are used for community acquired infective endocarditis?

A

Ampicillin with flucloxacillin with gentamycin

59
Q

What antibiotics are used for community acquired infective endocarditis for people allergic to penicillin?

A

Vancomycin with gentamycin

60
Q

What antibiotics are used for early PVE and healthcare infective endocarditis?

A

Vancomycin with gentamycin with rifampin

61
Q

What are predictors of a poor prognosis?

A

Older age

Prosthetic valve infective endocarditis

Complications such as heart failure or renal failure

The organism being staphylococcus aureus or fungi

62
Q

What are comlications and indications for surgery?

A

Heart failure in infective endocarditis

Uncontrolled infection

Prevention of systemic embolism

63
Q

What can infective endocarditis be prevented by?

A

Using prophylaxis when performing procedures where the patient is at risk of getting infective endocarditis

Good dental hygiene

Disinfection of wounds

Cardiovascular System (41 decks)

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