Infective endocarditis & Rheumatic Heart Disease Flashcards
What is infective endocarditis?
Inflammation of the endocardium
RECAP- what is the endocardium?
Inner layer of the heart
What happens in infective endocarditis after the valve has been colonised by bacteria?
The vegetation enlarges by further cycles of platelet-fibrin deposition and bacterial proliferation
What is the main characterisation of infective endocarditis?
The presence of vegetations
What are some predisposing factors which can lead to infective endocarditis?
-Prosthetic valves
-Cardiac devices (permanent pacemakers, defribillators)
-Intravenous drug users
-Congenital Heart disease
-Rheumatic valve disease (developing countries)
-Mitral valve prolapse
-Immunosuppression
-Prolonged admission to ITU/hospital (health-care associated IE)
What are some of the signs/ symptoms of infective endocarditis?
Fever (90%)
-Chills/Rigors
-Poor appetite
-Weight loss
Heart murmur (85%)
What are some of the less common signs/ symptoms of IE?
Less frequent: myalgia, abdo/back pain, confusion
Embolic complications (phenomena) 25%.
What might you see upon clinical examination in those with IE?
Osler nodes
Janeway lesions
Splinter haemorrhages
Roth Spots
Describe Osler Nodes
Red-purple, slightly raised, tender lumps, often with a pale centre.
Pain often precedes thedevelopmentof the visiblelesionby up to 24 hours.
Where are Osler Nodes usually found?
They are typically found on the fingers and/or toes.
Describe Janeway lesions
Rare, non-tender, smallerythematousorhaemorrhagicmacular,
papularornodularlesions
Few mm in dimeter
Where are Janeway lesions usually found?
Palms or soles
Describe splinter haemorrhages.
Looklike thin, red to reddish-brown lines of blood under the nails.
Describe Roth Spots.
White centered retinal hemorrhage
What are some of the laboratory signs of all infection helping with the diagnosis found in blood tests?
Elevated C-reactive protein
Erythrocyte sedimentation
Leucocytosis
Anaemia
Microscopic haematuria
What must be taken before antibiotic therapy is commenced in IE?
Three sets of blood cultures, 30 mins apart
What is the point of during three sets of blood cultures before starting antibiotics in those w IE?
It isolates the pathogen so we know what to treat
Which two bacteria most commonly cause IE?
Staphyloccus aureus.
Streptococci (Viridans, gallolyticus)
Name tow other bacteria which can cause IE but less commonly.
Enterococci
Coagulase negative Staphylococci.
If a patient has a negative cultures for endocarditis?
They may still have it, it just may not be caused by one of the common pathogens
List some of the bacteria/fungi which can cause IE but are identified after the first more generic blood culture has been taken.
Brucella spp
Coxiella burnetti
Bartonella spp
Tropheryma whipplei
Mycoplasma spp
Legionella spp
Fungi (Candida and Aspergillus)
Again, just read through and try to remember a couple, idk how essential this is
Which types of imaging are usually used in the diagnosis of IE?
Transthoracic echocardiogram- most important
Transoesophageal echo
CT/MRI
Positron emission tomography- helpful if diagnosis is unclear
Which criteria is used for the diagnosis of IE?
Modified Duke criteria
How many of the major/minor criteria from Modified Duke criteria gives a diagnosis of definite IE?
2 major
OR
1 major and 3 minor
OR
5 minors
