Lecture 22 - Endocarditis

Question 1

Clinical signs of endocarditis?

Answer 1

infection signs, embolic phenomena (e.g. splinter haemorrhage), abnormal heart valve

Question 2

Physiological effects of endocarditis?

Answer 2

cerebral, renal and splenic embolic infarcts, vegetations on aortic and mitral valve cusps

Question 3

Pathogenesis?

Answer 3

turbulent flow through abnormal valve -> platelet and fibrin attachment to damaged valvular epithelium -> vegetations -> transient bacteraemia infects vegetations -> shedding infected emboli + enlargement and valvular destruction

Question 4

Lack of neutrophil action?

Answer 4

lack of capillaries @ valves

Question 5

Diagnostic methods?

Answer 5

document continuous bacteraemia (repeated testing), murmur and vegetation on echocardiogram,

Question 6

Bacteraemia types?

Answer 6

true (more than one set can be positive, clinically compatible infective source), contaminant (only one set of blood cultures positive), and transient (only positive briefly)

Question 7

Aetiology of infection?

Answer 7

primarily strep., can be staph aureus

Question 8

Antimicrobial treatment?

Answer 8

considerations of sensitivity and resistance, bactericidal vs bacteristatic, dose and method, duration for cure and relapse prevention (weeks)

Question 9

Labelling as resistant?

Answer 9

if after 6 hours serum concentration required to kill is at higher deviation of requirement

Question 10

How rheumatic fever is unique from endocarditis?

Answer 10

Strep pyogenus only, pharyngitis, diffuse inflammation not infection, nodules on valves not vegetations, raised ESR and CRP, fever, oral penicillin 10 days rather than IV for month, IM prophylaxis not oral