Mehl. endocarditis 03-15 (1) Flashcards
Acute endocarditis. definition?
Bacterial infection of valve in patient with no previous heart valve problem
SUBacute endocarditis. definition?
Bacterial infection of valve in patient WITH HISTORY of valve abnormality (ie congenital bicuspid aortic vale, Hx of rheumatic heart disease)
Acute endocarditis. M/o?
S. aureus
Acute endocarditis. Valves affected?
Left sided heart - mitral and aortic.
These affected because of greater pressure changes (ie from high to low) within left heart, resulting in turbulence that enables seeding.
Acute endocarditis. What valves in i/v drug users?
Vegetations on tricuspid
SUBacute endocarditis. Mos?
Strep. viridans.
It can be broken down into: S. sanguinis, S. mutans, S mitis.
SUBacute endocarditis. Hx of what?
Hx of dental procedure is HY precipitating event, due to inoculation of blood occurs via oral cavity —> previously normal valves get infected.
Random points. CP combination of two?
New-onset murmur + fever = endocarditis until proven othervise
Random points. What CBC finding?
Reactive thrombocytosis can occur due to infection.
Not specific for endocarditis
Random points. Why hematuria can occur?
vegetations launch off –> goes to kidney –> hematuria
Random points. Endocarditis + stoke like episode (ie focal neurologic sign) =?
SEPTIC EMBOLUS that launched off to brain
Random points. Janeway lesions, osler nodes, splinter hemorrhages = low yield for USMLE
.
Random points. HACEK - nonexistent on USMLE
.
Mx. FIRST STEP?
BLOOD CULTURE
Mx. SECOND STEP?
after culture –> ANTIBIOTICS
What confirms diagnosis after blood cultures?
TRANSESOPHAGEAL ECho (TEE)
TTE - NOT DONE FOR ENDOCARDITIS
Empiric Tx for 2CK?
Vancomycin + Gentamicin or ampicilin/sulbactam
What targets vancomycin?
gram positive (including MRSA)
What targets gentamicin?
gram negative
what prophylaxis is given prior dental procedure?
Ampicilin
OR
second generation cephalosporin (eg cefoxitin)
Indications for prophylaxis? 4
Hx of endocarditis
Prosthetic material in the heart
Any congenital cyanotic heart disease that has not been completely repaired (if repaired with prosthetics = give prophylaxis)
Hx of heart transplant with valvular regurgitation or any kind
Highest yield point regarding regurgitation + prophylaxis?
Mitral valve prolapse (MVP) and valve regurgitation or stenoses ARE NOT INDICATION for prophylaxis.
in other words: do not give prophylaxis if the patient had MVP, MR, AS etc
Bicuspid aortic valve is NOT and indication
Mehl. Rheumatic heart disease (rheumatic fever) HY points. Mos?
Strep pyogenes (Group A Strep) oropharyngeal infection results in production of antibodies against S. pyogenes’ M-protein that cross-react with the mitral valve (i.e., molecular mimicry; type II hypersensitivity)
Mehl. Rheumatic heart disease (rheumatic fever). Valves?
Can occur with the aortic valve in theory, but on USMLE, it is always mitral valve.
Mehl. Rheumatic heart disease (rheumatic fever). valve changes?
Results in mitral regurgitation acutely and mitral stenosis late, as discussed earlier.
Mehl. Rheumatic heart disease (rheumatic fever). CP?
Presents as JONES (J©NES):Joints (polyarthritis), © Carditis, subcutaneous Nodules, Erythema marginatum (annular, serpent-like rash), Sydenham chorea (autoimmune basal ganglia dysfunction that results in dance-like movements of the limbs)
Mehl. Rheumatic heart disease (rheumatic fever). Cutaneous Group A Strep infections?
don’t cause rheumatic fever, but can still cause PSGN.
Mehl. Rheumatic heart disease (rheumatic fever). Tx?
penicillin.
