Lecture 6: Endocarditis Flashcards
What valve is MC involved in endocarditis
Mitral valve
note: MC - LC = M > A > T > P
What are the 4 major/specific types of Endocarditis
4 major types of Endocarditis
- ABE (Acute Bacterial)
- SBE (Subactue Bacterial)
- Endocarditis in Drug Users
- PVE (Prosthetic Valve Endocarditis)
What are the other 2 classifications/types (more general) of Endocarditis
and which is MC?
Type of Endocarditis
- Non-Bacterial
- Transient Bacteremia
Transient Bacteremia
3 main causes/sources of infection
Transient Bacteremia: causes/sources of infection
- valvular adherence
- Oral flora
- GI/GU flora
Transient Bacteremia: causes/sources of infection
- what is the MC cause
MC cause/source of Transient Bacteremia
- Dental procedures
Transient Bacteremia:
what are 3 ways bacteria evade the host response
Transient Bacteremia: evading the host response b/c
- bacteria sequestered by fibrin matrix
- decr metabolic activity in vegetation
- decr susceptibility to ABX that work on cell wall
2 main things that contribute to the pathogenesis of Endocarditis
Pathogenesis of Endocarditis
- Turbulent Flow
- Structural Dz
What is the classic triad a/w Endocarditis
Endocarditis triad
- Fever
- Anemia
- Heart murmur
Endocarditis: Other manif
- What categories of are common in Endocarditis (3 things)
Endocarditis: Other manif
- Systemic manif (constitutional Sxs)
- MSK manif
- GI manif (HSM)
Endocarditis: Peripheral Manifestations
- name the 6 seen
Endocarditis: Peripheral Manifestations
- Conjuctival Petechiae
- Splinter hemorrhages
- Osler’s nodes
- Janeway lesions
- Roth’s Spots
- Septic Emboli
Endocarditis: Peripheral Manifestations
- where are conjuctival petechiae located
- where are splinter hemorrhages located, a/w?
- where are osler’s nodes located, painful?
- Where are Janeway lesions located?
- What are they?/where are Roth’s spots located?
Endocarditis: Peripheral Manifestations
- Conjuctival Petechiae = inner eyelid
- Splinter hemorrhages = nails, a/w clubbing
- Osler’s nodes = pads of fingers/toes
- Janeway lesions = palms + soles
- Roth’s Spots = hemorrhages on retina
Endocarditis Dx
- 4 main tests used to Dx it
Endocarditis Dx
- blood cultures
- ECHO
- EKG
- Labs
Endocarditis Dx and ECHO
- Which type typically done first
- Which type is better/more sensitive
Endocarditis Dx and ECHO
- TTE = usu done 1st
- TEE = better/more sensitive
Endocarditis Dx and EKG
- 2 things seen on EKG a/w endocarditis
Endocarditis Dx and EKG
- conduction abn
- arrhythmias
Endocarditis Dx and Labs
- what are the 3 MC lab abn a/w endocarditis
Endocarditis Dx and Labs
- incr ESR
- Anemia
- Abn UA (hematuria)
Endocarditis Dx and Duke Criteria
3 options for Dx based on clinical criteria
Endocarditis Dx and Duke Criteria (need 1 of below)
- 2 major
- 1 major + 3 minor
- 5 minor
What are the 2 major Duke Criteria
Major Duke Criteria
- blood culture
- TTE/TEE
- RF
- T > 38
- Vascular + embolic lesions
- Immunologic lesions
- Atypical organism
- blood cult (not meeting major criteria)
- ECHO (not meeting major criteria)
what are these examples of
Minor Duke Criteria
- RF
- T > 38
- Vascular + embolic lesions
- Immunologic lesions
- Atypical organism
- blood cult (not meeting major criteria)
- ECHO (not meeting major criteria)
What are the 2 main NON-cardiac complications a/w endocarditis
NON-cardiac complications a/w endocarditis
- Emboli
- Metastatic abscesses
What is the general Tx for endocarditis (duration)
high dose, long term ABX (4-6 wks)
Endocarditis Tx
What 3 species need synergy w/ABX tx
Endocarditis Tx: synergy for
- Enterococci
- Some Streptococci
- Pseudomonas
Tx of Fungal Endocarditis
- what ABX can be attempted?
- What is the typically necessary Tx method?
Tx of Fungal Endocarditis
- Attempt Tx w/Amph B but….
- typically need surgery
- CHF
- uncontrolled sepsis
- Conduction abn
- Myocardial abscess
- fungal endocarditis
- Recurrent systemic embolization
- Prosthetic valve
are indications for ______
- CHF
- uncontrolled sepsis
- Conduction abn
- Myocardial abscess
- fungal endocarditis
- Recurrent systemic embolization
- Prosthetic valve
are indications for early surgical intervention
What is the MC cause of ABE (acute bacterial endocarditis)
- what 2 groups of pts is this type common in
ABE
MC cause = staph aureus
- common in IVDA and HIV pts
Tx of ABE
- what are the 2 options (2 drugs in each)
Tx of ABE
- Naficillin + Gentamycin or ….
- Vanco + Gentamycin
What is the MC cause of SBE (Subacute Bacterial Endocarditis)?
What is the MC cause of SBE = Strep Viridans
Other than Strep Viridans what other 2 groups of bacteria cause SBE
Causes of SBE
- Group D strep
- Coag (-) Staph
Causes of SBE: Coag (-) staph
- what is its unique virulence factor
- what other type of endocarditis is it MC a/w
Causes of SBE: Coag (-) staph
- unique virulence factor = slime
- MC a/w PVE
How does the general Tx of SBE different from acute
can delay Tx in SBE if stable
acute –> immed Tx
Tx of SBE (gentamycin always given)
- what are the 2 main drug options given w/Gentamycin
Tx of SBE
- PCN or Ampicillin w/Gentamycin
ABE vs SBE
- Which is a/w a damaged valve
- Which is the source Dental or GI? IVDA, Skin?
- Which is the MC cause Strep
- Which has insidious onset and slower course
- Which has marked fever/toxicity (pts ill appearing)
- Which has rapid change in cardiac fxn and higher mortality?
ABE vs SBE
- damaged valve = SBE
- Source Dental or GI = SBE
- Source IVDA, Skin = ABE - MC cause is Strep = SBE
- Insidious onset and slower course =SBE
- Marked fever/toxicity (pts ill appearing) = ABE
- Rapid change in cardiac fxn and higher mortality = ABE
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?
MC valve = TRICUSPID in IVDU
What bacteria is the MC cause of Endocarditis in IVDU and what is there a high incid of in this pop
Endocarditis in IVDU
MC cause = Staph Aureus w/high incid of MRSA
PVE: Prosthetic Valve Endocarditis
- What is the MC cause for early cases ( < 60 days)
- What is the MC cause for late cases (> 60 days)
PVE: Prosthetic Valve Endocarditis
- Staph Epidermis = MC cause for early cases ( < 60 days)
- Strep Viridans = MC cause for late cases (> 60 days)
Tx of PVE
- what 3 ABX combo used for PVE assoc S. aureus
- what is the typical method of tx
Tx of PVE
- PVE assoc S. aureus –> Vanc + Gentamycin + Rifampin
- typical Tx method = valve replacement
4 main causes of Culture negative endocarditis
Culture negative endocarditis
- Prior ABX
- Fungi
- Organisms that dont grow on cultures
- Non-infectious causes
Culture negative endocarditis
- 2 examples of organisms that dont grow on cultures
Culture negative endocarditis: organisms that dont grow on cultures
- Coxiella burnetti
- Chlamydia psittaci
Culture negative endocarditis
- 2 examples of non-infectious causes
Culture negative endocarditis: non-infectious causes
- Marantic endocarditis
- Libman-sacks endocarditis
- Prosthetic heart valves
- Prior endocarditis
- Major Congential heart Dz
- Cardiac transplant w/cardiac valve dz
- Heart repairs using prosthetic materials
are indications for ______
- Prosthetic heart valves
- Prior endocarditis
- Major Congential heart Dz
- Cardiac transplant w/cardiac valve dz
- Heart repairs using prosthetic materials
are indications for Endocarditis PPx
Endocarditis PPx
- what should be given as PPX before dental procedure (in those pts that its indicated)
ppx for Endocarditis before dental procedure = PO Amoxicillin (2 g)
