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ICC1 > infective endocarditits > Flashcards

infective endocarditits Flashcards

1
Q

what is the pathophysiology of infective endocarditis ?

A

endocardium is damaged due to turbulent blood flow
causes a platelete-fibrin deposition
transient bacteriemia
adherence of bacteria to blood clot
multiplication of the bacteria to cause a vegetation
parts of the vegetation embolises
immunological stimulation forms immune complexes

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2
Q

what are the predisposing factors of infective endocarditis ?

A
  1. damaged valves/turbulent blood flow such as with atherosclerotic heart disease
  2. transient bacteremia as with intravenous drug abusers
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3
Q

can infective endocarditis happen to a normal valve ?

A

yes as with the cases of staph aureus in an immunocompromised patient

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4
Q

what is the course of symptoms in infective endocarditis ?

A

insidious but can be acute

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5
Q

what are the main presenting symptoms of IE ?

A 
fever is present in more than 95% of patients 
fatigue 
shortness of breath 
nausea 
myalgia
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6
Q

what are the signs of IE?

A 
fever 
pallor 
new or changing murmur 
right or left ventricular failure 
hepatomegaly/splenomegaly 
emboli sequela 
oslers nodes, splinters
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7
Q

what are the peripheral stigmata of IE?

A

Roth spots, Osler nodes, Janeway lesions, and splinter hemorrhages

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8
Q

what are the vascular complications of IE?

A

embolic lesions originating from the vegetations
mycotic aneurysms that could cause obstructions anywhere

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9
Q

when are immunological sequelae more commonly seen ?

A

in subacute presentations of IE

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10
Q

what are the complications of the immunological sequale?

A

immune mediated vasculitis:
glomerulonephritis
oslers nodes
splinter haemorrhages

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11
Q

what are the classifications of IE ?

A

divided into native valve and prosthetic valve

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12
Q

how do we differentiate between an early and a late prosthetic valve ?

A

less than 6 months from insertion

more than 6 months from insertion

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13
Q

which valve is most likely to affected with IVDU ?

A

tricuspid valve

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14
Q

what is the most common causative organism with native valve endocarditis ?

A

viridans streptococci
staphylococcus aureus
could possibly be culture negative

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15
Q

where does viridans streptococci exist ?

A

normal flora of the oropharynx

gut flora

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16
Q

what kind of hemolysis happens with viridans streptococci and what gram stain is it ?

A

alpha hemolysis ( partial hemolysis )
gram positive in long chains

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17
Q

what are HACEK group of organisms ?

A

gram negative organisms
difficult to grow
difficult to treat

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18
Q

what are the causes of culture negative infective endocarditis in native valves ?

A

HACEK organisms
previous antibiotic therapy
Candida spp.
fastidious streptococci

19
Q

how can you make a diagnosis of culture negative infective endocarditis ?

A

prolonged cultures and fungal cultures
serology - paired sera

serology - paired sera

20
Q

when is prosthetic valve endocarditis highest risk ?

A

first 2 months following the procedure

21
Q

what are the causative organisms of early prosthetic valve endocarditis ?

A

( first 6 months)
s.aureus
coagulase negative staphylococci e.g staphylococcus epidermidis

22
Q

what are the causative organisms of late prosthetic valve endocarditis ?

A

viridans streptococci
staph. aureus

23
Q

how do you make a diagnosis of prosthetic valve endocarditis ?

A

blood culture is the most important investigation

Echocardiogram ( trans-oesophageal and trans thoracic)

24
Q

what are the specific steps required to collect a blood sample for culture ?

A

collect at least 2 sets , ideally 3 before the start of therapy
collect them over a 1-2 hour period in acutely ill patients but in a longer period in more stable patients

25
Q

what is the criteria for diagnosing infective endocarditis ?

A

Modified duke’s criteria

26
Q

what are the major criteria in modified duke’s criteria ?

A

1- positive blood cultures or organisms seen in histology ( 2 separate samples , only one if thee organism is coxiella )
2- evidence of myocardial involvement on echo
3- new valvular regurgitation

27
Q

what are the minor criteria in duke’s modified criteria ?

A

-predisposition or IV drug abuse
-fever
-vascular :
septic pulmonary infarction
intracranial haemorrhages
-immunological:
glomerulonephritis ( microscopic hematuria )
osler’s nodes ( tender nodules )
splinters
-serology:
coxiella burnetti

28
Q

how many of each of the criteria is required to make a diagnosis of IE?

A

to make a definitive diagnosis of IE :
2 major
or
1 major and 3 minor
or
all 5 minor

29
Q

what are the requirements to make a possible diagnosis of IE ?

A

1 major and 1 minor or 3 minor

3 minor

30
Q

what medical treatment would be given to an IE patient generally ?

A

high dose, regular and intravenous empirical antibiotics after peripheral blood sampling

31
Q

which antibiotics are given with native valves ?

A

amoxicillin and gentamicin

32
Q

which antibiotics are given with prosthetic valves ?

A

vancomycin and gentamicin

33
Q

what must be monitored and measured after giving antibiotics to IE patient ?

A

Measure minimum inhibitory concentration (MIC)

34
Q

what to give for streptococcal endocarditis involving a native valve that is penicillin sensitive ?

A

7.2g of penicillin in 6 individual doses
IV gentamicin 80 mg for 2 weeks

IV gentamicin 80 mg for 2 weeks

35
Q

what to give for staphylococcal endocarditis for MSSA and MSSE ?

A

MSSA: staph aureus
MSSE : staph epidermidis
fluxocallin 12g daily and IV gentamicin

36
Q

what to give for staphylococcal endocarditis for MRSA and MRSE ?

A

vancomycin and gentamicin or rifampcin for a duration of 4-6 weeks

37
Q

when would we consider a patient for surgery?

A

1- if the patient develops heart failure or persistent fever or recurrent embolism
2- presence of large vegetations
3- intracardiac abscess
4- acute valvular regurgitation with pulmonary oedema
4- dehiscence of a prosthetic valve
5- infection with candida or coxiella , refractory enterococcal endocarditis

38
Q

what are the preventative measure to take to avoid infective endocarditis ?

A

1- aseptic techniques for operations
2- dental care prior to valve operations

39
Q

what is the is the most sensitive diagnostic test for IE ?

A

TOE

40
Q

what can be seen on ECG of a patient with infective endocarditis that serves as an indication for surgery?

A

PR interval prolongation , which indicates aortic root abscess formation

41
Q

streptococcus bovis ?

A

can cause both infective endocarditis and colorectal cancer

42
Q

what is the posterior relation and superior relation of the left atrium ?

A

posterior: oesophagus
superior : pulmonary trunk

43
Q

what type of emboli are associated with right sided lesions ?

A

septic pulmonary emboli

44
Q

what type of emboli is associated with left sided lesions ?

A

may embolize to any tissue

ICC1 (50 decks)

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