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Clin Med - ID > Lecture 6 - Endocarditis > Flashcards

Lecture 6 - Endocarditis Flashcards

1
Q

Acute Bacterial Endocarditis

A

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
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2
Q

Subacute bacterial endocarditis

A

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

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3
Q

What is the median age of infective endocarditis?

A

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

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4
Q

Non-bacterial Thrombotic endocarditis

A

endothelial cell damage
hypercoagulability

RF: 
valvular heart disease 
malignancies (adenocarcinomas) 
connective tissue disorders
intracardiac catheters
prolonged febrile illness
persistent fetal circulation
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5
Q

Which common heart defects can put a pt an increased risk of infective endocarditis?

A

bicuspid aortic valve
mitral valve prolapse (holosystolic murmur?)
VSD

degenerative: calcific aorta stenosis, calcified mitral annulus

prosthetic heart valve
rheumatic heart disease

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6
Q

Which valves are most commonly involved in endocarditis?

A

mitral > aortic > tricuspid > pulmonic

Tricuspid is MC for IV drug users since this is the first valve the blood hits when entering the heart

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7
Q

What is the most common pathogen responsible for subacute bacterial endocarditis?

A

viridans strep

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8
Q

What is the most common pathogen responsible for acute bacterial endocarditis?

A

staph aureus

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9
Q

What is the common cause of culture negative endocarditis?

A

rare overall but these are typically things that do not grow on culture well

chlamydia 
coxiella burnetii (Q fever --new bird at home)
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10
Q

IVDU with endocarditis most commonly involve which valve?

A

tricuspid valve (this is the first vlalve that venous blood hits when hitting the heart)

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11
Q

What is the classic triad for endocarditis?

A

fever
anemia
heart murmur

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12
Q

What is the clinical manifestation of endocarditis?

A

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)
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13
Q

Oslers nodes

A

seen with endocarditis

PAINFUL nodules on pads of fingers and toes

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14
Q

Janeway lesions

A

seen with endocarditis

non-tender erythematous macules on palms and soles

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15
Q

Roths spots

A

seen with endocarditis

retinal hemorrhages with/without pale centers

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16
Q

Clinical manifestation SBE vs ABE

A 
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%
17
Q

What is the incubation period for endocarditis?

A

85% within 2 weeks

18
Q

What lab findings will you see with endocarditis?

A

increase ESR (90-100% pts)
anemia (70-90% of pts)
abnormal UA -hematuria (50%)

19
Q

Dukes Criteria

A

look in PPP

20
Q

What are some non-cardiac complications seen in endocarditis?

A

emboli (CNS, mycotic aneurysms, systemic)

metastatic abscess: brain, lung, spleen, kidney

antigen-antibody complex disease (glomerulonephritis)

21
Q

What is the treatment for endocarditis?

A

high dose IV ABX after blood culture to know which bacteria your ABX are aiming for

+/- surgery

22
Q

Who gets surgery for endocarditis?

A

CHF
recurrent systemic embolization
uncontrolled sepsis
fungal endocarditis (no fungal drug will ever reach high enough concentrations to reach the heart)

23
Q

Endocarditis prophylaxis

A

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)

Clin Med - ID (9 decks)

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