Infective Heart Disease and HEart Failure

Question 1

What is teh most common s for infectious endocarditis?

Answer 1

staph aureus
staph epidermidis(coag neg)
virdan strep
enterococci

Question 2

What are properties of successful IE pathogens?

Answer 2

survive antimicrobial components of serum

able to adhere to endocardium

Question 3

What allows viridan strep to bind endocardium?

Answer 3

dextran(exopolysaccharide) and adhesins that mediate attachment to platelets and fibrin

Question 4

What allows staph aureus to bind endocardium?

Answer 4

s. aureus, fibrinogen-binding adhesins

Question 5

what is the life in a vegetation for infectious endocarditis?

Answer 5

-heterogenous matrix of deposited stuff
protection from immune cells
bacteria can achieve high density

Question 6

What type of antibiotic therapy do you need for infectious herat disease

Answer 6

bactericidal activity
parental admin for sustained activity
long term tx

Question 7

What is the mechanism of action of vancomycin?

Answer 7

binds to D-ala-Dala at the petpide size of peptidoglycan

Question 8

What does daptomycin mechanism of action and spectrum?

Answer 8

bacteriaicidal, narrow spectrum

bind and disrupt cyctoplsmic membrane, possibly via loss of membrane potential

Question 9

What does rifampin target adn mechanism of action?

Answer 9

binds to and inhibits RNA pol

bacteriacidal, gram pos

Question 10

Gentamicin works well in combination with what?

Answer 10

30S inhibitor that works well with cell wall disrupters.

Question 11

What are the predisposing procedures for endocarditis?

Answer 11

dental work or poor hygene, skin dsirupsttion
hemodialysis
IVDU
focal infection with typical organism

Question 12

What is the clinical presentation of endocarditis?

Answer 12

acute or subacute onset
fever large majority
heart murmur80%
chills sweats 40-75%
anorexia malaise weight loss 25-50%
lab abnormalities

Question 13

What are noncardiac manifestations of endocarditis?

Answer 13

embolic events
splenomegaly
clubbing
petechiae

Question 14

What are the lab abnormalities associated with endocarditis?

Answer 14

anemia 70-90%
leukocytosis 20-30%
microscopic hematuria
elevated sed rate and c reactive protein

Question 15

What are the most common causes of endocarditis in different pts pop?

Answer 15

strep and staph aureus for acute
coag neg staph for prosthetic
enterococcus in elderly

Question 16

What are the culture negative endocarditises?

Answer 16

HACEK
Haemophilus aphrophilus
Actinobacillus
cardiobacterum hominis
eikenella corrodens
Kingell kingae

+ others

Question 17

Diagnosis of endocardtisi is made how?

Answer 17

two major, one major plus 3 minor of Duke criteria

Question 18

What are the major indications in the duke criteiria?

Answer 18

typical organism from 2 sep blood cx
organism from persistently pos blood cx
posserology for c. burnetti
evidence of endocardial involvment
-new valvurla regurgitation
-+echo

Question 19

What are the minor indications of the duke criteria?

Answer 19

predisposition to infective endocarditis
fever
vascular phenomena
immunologic phenomena
microbologic not meeting major criteria

Question 20

What are the indications for surgery in endocarditis?

Answer 20

CHF
prosthetic valve endocarditis
valve perforation or rupture
heart block
mutliple emoblicevent
uncontrolled infection on appropiate Rx
uncertain pathogen poorly tx (fungi)

Question 21

What are compications of endocarditis?

Answer 21

cardiac -CHF,, Heart block, vlave failure, absecess or fistur
neurologic, embolic stroke, myotic aneurysm, menigintis
septic emboli abscesses

Question 22

What are mycotic anuerysms?

Answer 22

usually silent until bleed, most common pperipheral MCA, most common with viridians strep