Lecture 5 Endocarditis Flashcards
Infective endocarditis may involve the ____ lining of the heart, the ____ ___, and/or the ____
inner, chordae tendinae, valves
_____ causes acute endocarditis with large vegetations on previously normal valves
S. Aureus
______ causes subacute endocarditis with small vegetations on damaged valves
S. viridans
coag ____ staph ____ can cause endocarditis on prosthetic valves
negative, epidermidis
Strep _____ is seen in the elderly and is present in colon cancer
bovis
most common culture negative encocarditis:
Coxiella burnetti, bartonella, HACEK (Hemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)
Symptoms: "FROM JANE" F = R = O = M =
fever, Roth spots, osler nodes, murmur
Symtpoms: "FROM JANE" J = A = N = E =
Janeway lesions, anemia, Nail-bed hemorrhages, Emboli
other = symptoms of chronic disease ie fever, weight loss, fatigue, night sweats, petechiae
What are Roth spots?
round white spots on retina surrounded by hemorrhages
Osler nodes:
painful or painless?
location?
due to what?
painful (OUCH for osler) raised nodules;
tips of fingers and toes;
vasculitis
Janeway lesion:
painful or painless?
location?
due to what?
painless nodules;
palms/soles;
microemboli
____ ____ are seen in subacute endocarditis in a time course of hours to days
osler nodes
____ ____ are seen in acute endocarditis in a time course of days to weeks
janeway lesions
Major Criteria:
- Lab evidence: at least ___ blood cultures, unless _____
- _____: use echocardiogram
- _______
2, coxiella burnetti;
- endocardial involvement
- new valvular regurg
Minor criteria:
- Predisposing heart condition risk
- ____
- _____ phenomenon such as emboli, hemorrhages
- _____ phenomenon such as glomerulonephritis or positive rheumatoid factor
- positive blood culture (atypical ? don’t know what his notes mean)
- fever,
- vascular.
- immunologic
How to diagnose?
___ major
__ major + ____ minor
__ minor
2;
1 and 3
5
Treatment of endocarditis:
if penicillin sensitive, use ____ and _____
if not, use ____ and _____
treat for 2-6 weeks
Penicillin (or Amp) + aminoglycoside;
vancomycin + aminoglyocside
should you use anti-coagulation?
no
Which is immune mediated, osler nodes or janeway lesions?
osler nodes
___ sided lesions increase with inspiration ie _____ regurgitation
right; tricuspid
Pansystolic murmur that decreases with inspiration:
mitral regurgitation
compliment levels ______ with endocarditis
decrease
_____ is used for prostethic valve endocarditis because it is more penetrative
rifampin
What kind of echo should be used for prostethic valves because it is “HD”
transesophageal
what bacteria is commonly seen in endocarditis in homeless alcoholics?
bartonella
