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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
what is the criteria for diagnosing infective endocarditis ?
Modified duke's criteria
26
what are the major criteria in modified duke's criteria ?
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
what are the minor criteria in duke's modified criteria ?
-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
how many of each of the criteria is required to make a diagnosis of IE?
to make a definitive diagnosis of IE : 2 major or 1 major and 3 minor or all 5 minor
29
what are the requirements to make a possible diagnosis of IE ?
1 major and 1 minor or 3 minor | 3 minor
30
what medical treatment would be given to an IE patient generally ?
high dose, regular and intravenous empirical antibiotics after peripheral blood sampling
31
which antibiotics are given with native valves ?
amoxicillin and gentamicin
32
which antibiotics are given with prosthetic valves ?
vancomycin and gentamicin
33
what must be monitored and measured after giving antibiotics to IE patient ?
Measure minimum inhibitory concentration (MIC)
34
what to give for streptococcal endocarditis involving a native valve that is penicillin sensitive ?
7.2g of penicillin in 6 individual doses IV gentamicin 80 mg for 2 weeks | IV gentamicin 80 mg for 2 weeks
35
what to give for staphylococcal endocarditis for MSSA and MSSE ?
MSSA: staph aureus MSSE : staph epidermidis fluxocallin 12g daily and IV gentamicin
36
what to give for staphylococcal endocarditis for MRSA and MRSE ?
vancomycin and gentamicin or rifampcin for a duration of 4-6 weeks
37
when would we consider a patient for surgery?
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
what are the preventative measure to take to avoid infective endocarditis ?
1- aseptic techniques for operations 2- dental care prior to valve operations
39
what is the is the most sensitive diagnostic test for IE ?
TOE
40
what can be seen on ECG of a patient with infective endocarditis that serves as an indication for surgery?
PR interval prolongation , which indicates aortic root abscess formation
41
streptococcus bovis ?
can cause both infective endocarditis and colorectal cancer
42
what is the posterior relation and superior relation of the left atrium ?
posterior: oesophagus superior : pulmonary trunk
43
what type of emboli are associated with right sided lesions ?
septic pulmonary emboli
44
what type of emboli is associated with left sided lesions ?
may embolize to any tissue

ICC1 (50 decks)

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