Infective Endocartitis Flashcards
What is Infective endocartitis
Infection of the Endocardium or endovascular structures
What are the risk factors of IE
AGE OVER 60
IMMUNOCOMPROMISED
MALE
IV DRUG USE (Staph. Aureus)
POOR DENTAL HYGIENE (Strep. Viridans)
RECENT DENTAL SURGERY (Strep. Viridans)
PROSTHETIC VALVES
VALVULAR DISEASE
What are the common infective organisms
Staph Aureus
Strep Viridans
Enterococci
Strep Bovis (colon lesion, IBD)
What are the features of Infective Endocartitis
FEVER WITH NEW MURMUR
Night sweat
Malaise
Weught loss
Rigors
Chest Pain
What are the 5 signs of IE
Janeway lesion - palma and sole
Osler nodes - fingers and toes
Splinter haemorrhage - nails
Roth spots - Eyes
Prolonged PR/AV Block
What is the basic pathology of IE
Vegetation of valves caused by platelet adhesion to damaged endothelium causing regurgitation
What are the investigations used in Infective Endocartitis
ECG (Prolonged PR = aortic root abscess)
Raised ESR/CRP
Transoesophagel ECHO
Blood culture (3 sites in 24hrs)
What is the Gold Standard investigation for IE
Transoesophageal ECHO
-Invasive but specific and sensitive
What is the Major Duke’s Criteria for IE
Blood culture
-3 cultures from 3 spots
Imaging
-ECHO shows vegetation/valve damage
What is the Minor Duke’s Criteria for IE
FEVER
NEGATIVE BLOOD CULTURE
ANY VASCULAR SIGN
ANY IMMUNOLOGICAL SIGN
HEART CONDITION / IV DRUG USE
How does the Duke’s criteria define IE
At least 2 major and 2 minor
Or all 5 Minor
What is the initial treatment for IE
S Aures? Vancomycin and Rifampicin
S Virdans? Benzylpenicillin and Gentamicin
Prosthetic valve replacement
What are the surgical indicators for IE due to complciation
Haemodynamically unstable
Heart fail
Severe sepsis
Infected Prosthetic valve
Aortic Root abscess (PR prolongation)
What are the surgical options for IE
Replace the valve
Remove the infected device
