Lec 13 Valvular Heart Disease III Flashcards
What is infectious endocarditis?
infection of heart’s endocardial surface = most commonly happens in leaflets where high frictional stress develops
What is acute IE?
affects normal heart valves
rapid destruction
large vegetations that can get dislodged and become septic emboli
if not treated = fatal w/in 6 wks
What causes acute IE?
staph aureus usually = high virulence
What is subacute IE?
affects damaged heart valves
develops slowly over days/mos
fatal by one yr if not treated
What causes subacute IE?
strep viridans usually = low virulence
What should you think someone goes to dentist and comes back with low grade fever that develops over wks?
likely subacute IE due to strep viridans
pt probably has some underlying problem with valve, congenital, rheumatic heart disease, etc
What is pathogenesis of infectious endocarditis?
turbulent blood flow –> thrombus forms at site of injury –> bacteria enters circulation –> bacteria adheres to injured endocardial surface
What types of cardiac lesions predispose to endocarditis?
- rheumatic valve disease or other acquired valve disease
- hypertrophic obstructive cardiomyopathy
- congenital heart disease
- surgically implanted device
What are symptoms of acute infective endocarditis?
high grade fever, chills, short of breath, pleurtic chest pain [embolism to lungs]
What are first aid mnemomic signs of infective endocarditis?
step1
bacteria FROM JANE
- Fever
- Roth spots [emboli to retina]
- Osler nodes [painful, finger + toe]
- Murmur
- Janeway lesions [painless palm/sole]
- Anemia [of chronic disease]
- Nail bed hemorrhage [splinter hemorrhage]
- emboli
What are subacute symptoms of endocarditis?
low grade fever, anorexia, weight loss, fatigue, arthralgias, ab pain, N/V
= signs of chronic disease
What are cardiac manifestations of infective endocarditis?
- new regurgitant murmurs
- CHF
- perivalvular abscess
- fistulae
- pericarditis
- MI = due to emboli to coronary arteries
Why should you scan the brain before giving someone with infectious endocarditis an anti-coagulant?
because may have emobolus to brain = get mycotic aneurysm
What should you think if you see oslers nodes?
strep viridans = likely subacute IE
relatively specific for infectious endocarditis = ainful red nodules on finger tips
What should you think if you see janeway lesions?
infectious endocarditis
relatively specific for infectious endocarditis = red, blanching macules, nonpainful
on palms and soles
What blood tests should you do if you think infectious endocarditis?
- do CBC for anemia
- do 3 blood cultures at separate sites to confirm bacteria
- do serology for negative culture bugs
- look for competing diagnosis for rheumatoid factor that might resemble infective endocarditis
Why do chest xray in infectious endocarditis? Why do EKG?
chest xray: look for focal infiltrates and calcification of heart valves, pneumonia, other foci of infection
EKG: look for evidence of ischemia and arrhythmias
Do blood cultures or start antibiotics first?
do blood cultures first so you can establish the cause
What are cardiac conditions for which antibiotic prophylaxis is reasonable?
- prosthetic heart valves
- prior history of infectious endocarditis
- unrepaired cyanotic congetical heart disease or repaired incompletely or w/in 6 mo
- valvulopathy after cardiac transplant
What are some procedures that warrant endocarditis prophylaxis?
dental procedures
upper resp tract procedures w/ incision of mucosa
GU/GI procedure if infection present
= basically anytime you invade the tissue
