Lecture 6 - Endocarditis Flashcards
Acute Bacterial Endocarditis
commonly IVDUs
rapid onset, fulminant course pts appear toxic extensive valve destruction substantial mortality commonly S. aureus, enterococcus OR: pneumococci, gonococci, group A, B strep
Subacute bacterial endocarditis
more commonly FUO
slow, indolent course
underlying valve abnormality
predominately alpha or gamma strep
coagulase negative staph
typical pt: had a murmur growing up, no harm..then recently had dental work done
What is the median age of infective endocarditis?
50-60
used to be 30 but d/t the declining incidence of rheumatic fever, increasing role of degenerative heart disease, increased aortic valve involvement
Non-bacterial Thrombotic endocarditis
endothelial cell damage
hypercoagulability
RF: valvular heart disease malignancies (adenocarcinomas) connective tissue disorders intracardiac catheters prolonged febrile illness persistent fetal circulation
Which common heart defects can put a pt an increased risk of infective endocarditis?
bicuspid aortic valve
mitral valve prolapse (holosystolic murmur?)
VSD
degenerative: calcific aorta stenosis, calcified mitral annulus
prosthetic heart valve
rheumatic heart disease
Which valves are most commonly involved in endocarditis?
mitral > aortic > tricuspid > pulmonic
Tricuspid is MC for IV drug users since this is the first valve the blood hits when entering the heart
What is the most common pathogen responsible for subacute bacterial endocarditis?
viridans strep
What is the most common pathogen responsible for acute bacterial endocarditis?
staph aureus
What is the common cause of culture negative endocarditis?
rare overall but these are typically things that do not grow on culture well
chlamydia coxiella burnetii (Q fever --new bird at home)
IVDU with endocarditis most commonly involve which valve?
tricuspid valve (this is the first vlalve that venous blood hits when hitting the heart)
What is the classic triad for endocarditis?
fever
anemia
heart murmur
What is the clinical manifestation of endocarditis?
fever, anemia, heart murmur (triad)
malaise, fatigue, anorexia, weight loss
arthralgias, back pain, arthritis
splenomegaly
conjunctival petecchiae splinter hemorrhages OSLERs nodes (painful nodules on pads of fingers and toes) JANEWAY lesions (non-tender erythematous macules on palms and soles) ROTHs spots (retinal hemorrhages with/without pale centers)
Oslers nodes
seen with endocarditis
PAINFUL nodules on pads of fingers and toes
Janeway lesions
seen with endocarditis
non-tender erythematous macules on palms and soles
Roths spots
seen with endocarditis
retinal hemorrhages with/without pale centers
Clinical manifestation SBE vs ABE
subacute: valve - damaged source - dental, GI organism - strep (alpha?) onset - insidious course - weeks, months fever - low grade cardiac function - slow mortality - 5-15%
acute: valve - normal source - skin, IV organism - Staph aureus onset - abrupt course - days fever - marked cardiac function - rapid change mortality - 30-50%
What is the incubation period for endocarditis?
85% within 2 weeks
What lab findings will you see with endocarditis?
increase ESR (90-100% pts)
anemia (70-90% of pts)
abnormal UA -hematuria (50%)
Dukes Criteria
look in PPP
What are some non-cardiac complications seen in endocarditis?
emboli (CNS, mycotic aneurysms, systemic)
metastatic abscess: brain, lung, spleen, kidney
antigen-antibody complex disease (glomerulonephritis)
What is the treatment for endocarditis?
high dose IV ABX after blood culture to know which bacteria your ABX are aiming for
+/- surgery
Who gets surgery for endocarditis?
CHF
recurrent systemic embolization
uncontrolled sepsis
fungal endocarditis (no fungal drug will ever reach high enough concentrations to reach the heart)
Endocarditis prophylaxis
AHA guidelines for pts with prosthetic heart valves or prior endocarditis or unreparied cyanotic congenital heart disease
prior to dental procedure:
amoxicillin 2gm PO
Cephalexin 2gm PO (if PCN allergy)
