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B2. 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
What is the process of a valve becoming inflammed and leading to infective endocarditis?
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
26
What are integrins?
Transmembranous proteins that bind to circulating fibronectin
27
What is bacteraemia?
Bacteria in the blood
28
What is bacteria in the blood called?
Bacteraemia
29
What does bacteraemia occur due to?
Invasive procedures Extra-cardiac infections Non-invasive activites
30
What are some examples of invasive procedures that can lead to bacteraemia?
Dental procedures GU and GI surgery Intravascular catheters
31
What are some examples of non-invasive activities that can lead to bacteraemia?
Chewing Tooth brushing
32
What are some examples of organisms that can cause infective endocarditis?
Virdans group streptococci Staphylococcus aureus Enterococci Coagulase negative staphylococci Fungi
33
What are the different classifications of infective endocarditis?
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
How is infective endocarditis not a constant disease?
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
What is seen for the diagnosis of infective endocarditis?
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
What is the presentation of infective endocarditis like in the elderly and immunocompromised?
Atypical
37
What are some common symptoms of infective endocarditis?
Fever Nigh sweats Malaise Fatigue Anorexia Weight loss Weakness Arthralgia Headache Shortness of breath
38
What are some clinical signs of infective endocarditis?
Cardiac murmur Janeway lesions Osler nodes Roth spot Splinter haemorrhage
39
What are janeway lesions?
Haemorrhagic, macular, painless plaques with predilection for palms and soles
40
What are haemorrhagic, macular, painless plaques with predilection for palms and soles called?
Janeway lesions
41
What are osler nodes?
Small, painful nodular lesion found on pads of fingers or toes
42
What are small, painful nodular lesion found on pads of fingers or toes?
Osler nodes
43
What is a splinter haemorrhage?
Tiny blood clots that run vertically under the nails
44
What are tiny blood clots that run vertically under the nails?
Splinter haemorrhage
45
What investigations are done for infective endocarditis?
Blood culture Blood tests Urinalysis ECG Chest X-ray Echocardiogram
46
Why is a blood test done for infective endocarditis?
Look for elevated acute inflammatory markers
47
Why is urinalysis done for infective endocarditis?
Test for blood
48
Why is a chest X-ray done for infective endocarditis?
Look for pulmonary congestion or abscess
49
What is the major criteria for the diagnosis to be infective endocarditis?
Blood culture positive (typical microorganism with 2 blood cultures) Image positive
50
What is minor criteria for the diagnosis to be infective endocarditis?
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
What criteria is required for the diagnosis of infective endocarditis to be definite?
2 major 1 major and 3 minor 5 minor
52
What criteria is required for the diagnosis of infective endocarditis to be possible?
1 major and 1 minor 3 minor
53
What criteria is required for the diagnosis of infective endocarditis to be rejected?
Resolution of endocarditis syndrome with antibiotic therapy for less than or 4 days
54
When should IV antibiotics be initiated for infective endocarditis?
3 sets of blood cultures (taken 30 mins apart) are positive
55
What is the treatment of infective endocarditis?
IV antibiotics
56
When does the type of antibiotics used for infective endocarditis change?
Depends on the classification of infective endocarditis
57
What are examples of different classifications of infective endocarditis?
Community acquired infective endocarditis Early PVE (\<12 months post surgery) infective endocarditis Healthcare associated infective endocarditis
58
What antibiotics are used for community acquired infective endocarditis?
Ampicillin with flucloxacillin with gentamycin
59
What antibiotics are used for community acquired infective endocarditis for people allergic to penicillin?
Vancomycin with gentamycin
60
What antibiotics are used for early PVE and healthcare infective endocarditis?
Vancomycin with gentamycin with rifampin
61
What are predictors of a poor prognosis?
Older age Prosthetic valve infective endocarditis Complications such as heart failure or renal failure The organism being staphylococcus aureus or fungi
62
What are comlications and indications for surgery?
Heart failure in infective endocarditis Uncontrolled infection Prevention of systemic embolism
63
What can infective endocarditis be prevented by?
Using prophylaxis when performing procedures where the patient is at risk of getting infective endocarditis Good dental hygiene Disinfection of wounds

B2. Cardiovascular System (41 decks)

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