Infective Endocarditis & Rheumatic Heart Disease Flashcards
what is endocarditis?
infection of inner layer of the heart
has mortality of endocarditis decreasing?
no stayed the same :(
for what reasons is endocarditis not a uniform disease?
various presentations
possibly dependent on underlying cardiac disease
microorganism involved
presence / absence of complications
underlying patient characteristics
what professions are involved for patients with endocarditis?
primary care physicians / acute medicine cardiologists surgeons microbiologists infectious disease (neurologists, neurosurgeons, radiologists, pathologists)
what gender is more likely to get endocarditis and which gender has the worse prognosis?
2:1 males have it but womens have worse prognosis
what are non-cardiac risk factors?
injection drug use diabetes chronic skin infections alcohol cirrhosis gastrointestinal lesions pneumonia
what are cardiac risk factors?
MVP(mitral valve prolapse) VSD (Ventricular Septal Defect) aortic stenosis rheumatic heart disease prothetic heart valcve
what are the classifications of infective endocarditis?
acute
subacute
chronic
what are non-specific symptoms?
fever
fatigue
malaise
what are signs of endocarditis?
congestive cardiac failure
immune complex deposisiton:splinter haemorrhages, vasculitic rash, roth spots, olsers nodes, janeway lesion
embolic phenomena
what is a vasculitic rash?
diffuse
non-blanching
petechial
purpuric
what are roth spots?
retinal haemorrhages
white/pale centre
coagulated fibrosis
what are olsers nodes
deep, red spots
painful
raised
finger pulps
what are janeway lesions?
flat, macular
echymotic
palms / soles
non-tender
what would give you a high index of suspicion?
fever new murmur pyrexia of unknown origin known IE causative organism prosthetic material PPM ICD prosthetic valve baffle / conduit previous IE congenital heart disease new conduction disorder immunocompromised / IVDA
who might the signs be abscent in?
elderly
after antibiotic treatment
immunocompromised
IE involving less virulent / atypical organisms
how would you investigate endocarditis?
use markers of infection/inflammation: FBC neutrophilia CRP ESR
blood cultures* prior to starting antibiotics
urinalysis
ECG
chest xray- heart failure, pulmonary abscesses
echocardiogram-TOE
what is the mircobiology involved in IE
streptococci
enterococci
staphylococcus
what are the different types of strept
oral viridans
S.milleri, S.angionosus group
group D strep
what are the three different types of enterococci?
E. faecalis
E. faecium
E. durans
what are the types of staphylococcus?
s.aureus
coagulase negative staph
whats the modified duke criteria?
identifying organism
providing evidence of infection anywhere within the heart
whats the treatment of endocarditis
antibiotics started as soon as all blood cultures taken. intravenous
+/- surgery
what does the choice of antibiotics depend on?
receieved prior antibiotics
native or prosthetic valve
what treatment would you give for native valves- 4 weeks
IV Gentamicin + IV Amoxycillin
what treatment would you give for native valves and sepsis
IV Vancomycin (as per protocol)
penicillin allergic
severe sepsis
MRSA
what treatment would you give for prosthetics - 6 weeks
Rifampicin (300-600mg IV/PO 12 hourly)
prosthetic valves
what are complications of endocarditis?
heart failure
fistula formation
leaflet perforation
uncontrolled infection
abscess formation
atrioventricular heart block
embolism
prosthetic valve dysfunction /dehiscence
what are indications for surgery?
heart failure
most frequent + severe complication
refractory pulmonary oedema
fistula formation
leaflet perforation
leaflet obstruction
prevention of embolism
what are the cardiac conditions most at risk of IE?
acquired valvular heart disease
stenosis
regurgitation
valve replacement
structural congenital heart disease
hypertrophic cardiomyopathy
previous IE
when do you offer prophylaxis?
an antibiotic that covers organisms that cause IE
if a person at risk of IE
is receiving antimicrobial therapy
due to undergoing a GI or GU procedure
at a site where there is suspected infection
when do you not offer prophylaxis?
dental procedures
non-dental procedures: upper/lower GI tract genitourinary tract urological gynaecological obstetric childbirth upper/lower respiratory tract ENT throat procedures bronchoscopy
what risk does body piercing and tatooing have?
infective endocarditis
what are the echocardiogram findings?
periannular complications severe left sided valv regurgitation low left ventricular ejection fraction pulmonary hypertension large vegetations
what are tge organisms involved?
s.aureus
fungi
gram negative bacilli
