Medi-endocarditis Flashcards
Endocarditis most commonly involves ___
Heart valves on the low pressure side
*can also affect VSD, intracardiac devices, damaged endocardium
Risk factors for endocarditis
- Hx of prior endocarditis
- Prosthetic valve or device
- Valvular heart disease
- Congenital heart disease
- Indwelling catheters
- IV drug users
- Immunosuppression
- Recent dental or surgical procedure
- Rheumatic heart disease
Men>women
Age>60
Primary portals of endocarditis
- Oral, Skin, and Upper resp tract
- strep, staph, HACEK - GI tract
- strep gallolyticus - GU tract
- enterococcus
HACEK organisms
Haemophilus Aggregatibacter Cardiobacterium Eikenella Kingella
Nosocomial organisms
Originates in the hospital
- Staph aureus
- CoNS
- Enterococcus
- Diphtheroids
- Facultative gram - bacillus
Tricuspid valve S. aureus (often MRSA) Embolization to lung Fever Faint or no murmur Cough, pleuritic chest pain, nodular infiltrates
IV drug use
Non tender macules on palms of hands and soles of feet
Janeway lesions
Tender subcutaneous nodules on pads of fingers and toes
Oslers nodes
Educative, edmatous hemorrhagic lesions of the retina with pale center
Roth spots
Endocarditis DX
- Duke criteria (2 major OR 1 major/3 minor OR 5 minor)
- Blood cultures (three 2 bottle cultures at different sites, 2 hours apart)
- CBC, Cr, electrolytes, liver function, sed rate
- Echo
- Telemetry monitoring
Empiric therapy for:
- IV drug users
- Health care associated
- Culture negative prosthetic valve
- Cover MRSA and gram -
- Cover MRSA
- Vanc, gentamicin, cefepime, rifampin if valve in place <1year
Anyone with staph aureus bacteremia should ALWAYS get what?
An echo
Any vegetation greater than ___ requires surgery
1 cm
Treatment for strep
Penicillin susceptible
Penicillin Ceftriaxone Vancomycin Penicillin PLUS gentamicin
Treatment for strep
Relative and moderately penicillin resistant
Penicillin or ceftriaxone
PLUS gentamicin, vancomycin
