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Infectious Diseases > Lecture 6: Endocarditis > Flashcards

Lecture 6: Endocarditis Flashcards

1
Q

What valve is MC involved in endocarditis

A

Mitral valve

note: MC - LC = M > A > T > P

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2
Q

What are the 4 major/specific types of Endocarditis

A

4 major types of Endocarditis

  1. ABE (Acute Bacterial)
  2. SBE (Subactue Bacterial)
  3. Endocarditis in Drug Users
  4. PVE (Prosthetic Valve Endocarditis)
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3
Q

What are the other 2 classifications/types (more general) of Endocarditis
and which is MC?

A

Type of Endocarditis

  1. Non-Bacterial
  2. Transient Bacteremia
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4
Q

Transient Bacteremia

3 main causes/sources of infection

A

Transient Bacteremia: causes/sources of infection

  1. valvular adherence
  2. Oral flora
  3. GI/GU flora
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5
Q

Transient Bacteremia: causes/sources of infection

- what is the MC cause

A

MC cause/source of Transient Bacteremia

- Dental procedures

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6
Q

Transient Bacteremia:

what are 3 ways bacteria evade the host response

A

Transient Bacteremia: evading the host response b/c

  1. bacteria sequestered by fibrin matrix
  2. decr metabolic activity in vegetation
  3. decr susceptibility to ABX that work on cell wall
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7
Q

2 main things that contribute to the pathogenesis of Endocarditis

A

Pathogenesis of Endocarditis

  1. Turbulent Flow
  2. Structural Dz
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8
Q

What is the classic triad a/w Endocarditis

A

Endocarditis triad

  1. Fever
  2. Anemia
  3. Heart murmur
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9
Q

Endocarditis: Other manif

  • What categories of are common in Endocarditis (3 things)
A

Endocarditis: Other manif

  1. Systemic manif (constitutional Sxs)
  2. MSK manif
  3. GI manif (HSM)
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10
Q

Endocarditis: Peripheral Manifestations

- name the 6 seen

A

Endocarditis: Peripheral Manifestations

  1. Conjuctival Petechiae
  2. Splinter hemorrhages
  3. Osler’s nodes
  4. Janeway lesions
  5. Roth’s Spots
  6. Septic Emboli
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11
Q

Endocarditis: Peripheral Manifestations

  1. where are conjuctival petechiae located
  2. where are splinter hemorrhages located, a/w?
  3. where are osler’s nodes located, painful?
  4. Where are Janeway lesions located?
  5. What are they?/where are Roth’s spots located?
A

Endocarditis: Peripheral Manifestations

  1. Conjuctival Petechiae = inner eyelid
  2. Splinter hemorrhages = nails, a/w clubbing
  3. Osler’s nodes = pads of fingers/toes
  4. Janeway lesions = palms + soles
  5. Roth’s Spots = hemorrhages on retina
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12
Q

Endocarditis Dx

  • 4 main tests used to Dx it
A

Endocarditis Dx

  1. blood cultures
  2. ECHO
  3. EKG
  4. Labs
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13
Q

Endocarditis Dx and ECHO

  1. Which type typically done first
  2. Which type is better/more sensitive
A

Endocarditis Dx and ECHO

  1. TTE = usu done 1st
  2. TEE = better/more sensitive
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14
Q

Endocarditis Dx and EKG

  • 2 things seen on EKG a/w endocarditis
A

Endocarditis Dx and EKG

  1. conduction abn
  2. arrhythmias
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15
Q

Endocarditis Dx and Labs

  • what are the 3 MC lab abn a/w endocarditis
A

Endocarditis Dx and Labs

  1. incr ESR
  2. Anemia
  3. Abn UA (hematuria)
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16
Q

Endocarditis Dx and Duke Criteria

3 options for Dx based on clinical criteria

A

Endocarditis Dx and Duke Criteria (need 1 of below)

  1. 2 major
  2. 1 major + 3 minor
  3. 5 minor
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17
Q

What are the 2 major Duke Criteria

A

Major Duke Criteria

    • blood culture
    • TTE/TEE
18
Q
  1. RF
  2. T > 38
  3. Vascular + embolic lesions
  4. Immunologic lesions
  5. Atypical organism
    • blood cult (not meeting major criteria)
    • ECHO (not meeting major criteria)

what are these examples of

A

Minor Duke Criteria

  1. RF
  2. T > 38
  3. Vascular + embolic lesions
  4. Immunologic lesions
  5. Atypical organism
    • blood cult (not meeting major criteria)
    • ECHO (not meeting major criteria)
19
Q

What are the 2 main NON-cardiac complications a/w endocarditis

A

NON-cardiac complications a/w endocarditis

  1. Emboli
  2. Metastatic abscesses
20
Q

What is the general Tx for endocarditis (duration)

A

high dose, long term ABX (4-6 wks)

21
Q

Endocarditis Tx

What 3 species need synergy w/ABX tx

A

Endocarditis Tx: synergy for

  1. Enterococci
  2. Some Streptococci
  3. Pseudomonas
22
Q

Tx of Fungal Endocarditis

  1. what ABX can be attempted?
  2. What is the typically necessary Tx method?
A

Tx of Fungal Endocarditis

  1. Attempt Tx w/Amph B but….
  2. typically need surgery
23
Q
  1. CHF
  2. uncontrolled sepsis
  3. Conduction abn
  4. Myocardial abscess
  5. fungal endocarditis
  6. Recurrent systemic embolization
  7. Prosthetic valve

are indications for ______

A
  1. CHF
  2. uncontrolled sepsis
  3. Conduction abn
  4. Myocardial abscess
  5. fungal endocarditis
  6. Recurrent systemic embolization
  7. Prosthetic valve

are indications for early surgical intervention

24
Q

What is the MC cause of ABE (acute bacterial endocarditis)

- what 2 groups of pts is this type common in

A

ABE

MC cause = staph aureus
- common in IVDA and HIV pts

25
Q

Tx of ABE

  • what are the 2 options (2 drugs in each)
A

Tx of ABE

  1. Naficillin + Gentamycin or ….
  2. Vanco + Gentamycin
26
Q

What is the MC cause of SBE (Subacute Bacterial Endocarditis)?

A

What is the MC cause of SBE = Strep Viridans

27
Q

Other than Strep Viridans what other 2 groups of bacteria cause SBE

A

Causes of SBE

  1. Group D strep
  2. Coag (-) Staph
28
Q

Causes of SBE: Coag (-) staph

  • what is its unique virulence factor
  • what other type of endocarditis is it MC a/w
A

Causes of SBE: Coag (-) staph

  1. unique virulence factor = slime
  2. MC a/w PVE
29
Q

How does the general Tx of SBE different from acute

A

can delay Tx in SBE if stable

acute –> immed Tx

30
Q

Tx of SBE (gentamycin always given)

  1. what are the 2 main drug options given w/Gentamycin
A

Tx of SBE

  1. PCN or Ampicillin w/Gentamycin
31
Q

ABE vs SBE

  1. Which is a/w a damaged valve
  2. Which is the source Dental or GI? IVDA, Skin?
  3. Which is the MC cause Strep
  4. Which has insidious onset and slower course
  5. Which has marked fever/toxicity (pts ill appearing)
  6. Which has rapid change in cardiac fxn and higher mortality?
A

ABE vs SBE

  1. damaged valve = SBE
  2. Source Dental or GI = SBE
    - Source IVDA, Skin = ABE
  3. MC cause is Strep = SBE
  4. Insidious onset and slower course =SBE
  5. Marked fever/toxicity (pts ill appearing) = ABE
  6. Rapid change in cardiac fxn and higher mortality = ABE
32
Q

Pts who is an IVDU presents to clinic for f/u after being diagnosed w/ endocarditis few months ago.

What valve is most likely involved?

A

MC valve = TRICUSPID in IVDU

33
Q

What bacteria is the MC cause of Endocarditis in IVDU and what is there a high incid of in this pop

A

Endocarditis in IVDU

MC cause = Staph Aureus w/high incid of MRSA

34
Q

PVE: Prosthetic Valve Endocarditis

  1. What is the MC cause for early cases ( < 60 days)
  2. What is the MC cause for late cases (> 60 days)
A

PVE: Prosthetic Valve Endocarditis

  1. Staph Epidermis = MC cause for early cases ( < 60 days)
  2. Strep Viridans = MC cause for late cases (> 60 days)
35
Q

Tx of PVE

  1. what 3 ABX combo used for PVE assoc S. aureus
  2. what is the typical method of tx
A

Tx of PVE

  1. PVE assoc S. aureus –> Vanc + Gentamycin + Rifampin
  2. typical Tx method = valve replacement
36
Q

4 main causes of Culture negative endocarditis

A

Culture negative endocarditis

  1. Prior ABX
  2. Fungi
  3. Organisms that dont grow on cultures
  4. Non-infectious causes
37
Q

Culture negative endocarditis

- 2 examples of organisms that dont grow on cultures

A

Culture negative endocarditis: organisms that dont grow on cultures

  1. Coxiella burnetti
  2. Chlamydia psittaci
38
Q

Culture negative endocarditis

- 2 examples of non-infectious causes

A

Culture negative endocarditis: non-infectious causes

  1. Marantic endocarditis
  2. Libman-sacks endocarditis
39
Q
  1. Prosthetic heart valves
  2. Prior endocarditis
  3. Major Congential heart Dz
  4. Cardiac transplant w/cardiac valve dz
  5. Heart repairs using prosthetic materials

are indications for ______

A
  1. Prosthetic heart valves
  2. Prior endocarditis
  3. Major Congential heart Dz
  4. Cardiac transplant w/cardiac valve dz
  5. Heart repairs using prosthetic materials

are indications for Endocarditis PPx

40
Q

Endocarditis PPx

- what should be given as PPX before dental procedure (in those pts that its indicated)

A

ppx for Endocarditis before dental procedure = PO Amoxicillin (2 g)

Infectious Diseases (9 decks)

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