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1st Year - Cardiology > Microbiology 1- Endocarditis and other cardiac infections > Flashcards

Microbiology 1- Endocarditis and other cardiac infections Flashcards

1
Q

What 2 symptoms together are endocarditis until proven otherwise?

A

Fever + new murmur

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2
Q

What is the main cause of infection on a normal valve?

A

Staph aureus

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3
Q

Does endocarditis on a normal valve tend to run an acute or subacute course?

A

Acute

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4
Q

Does endocarditis on an abnormal valve tend to run an act or subacute course?

A

Subacute

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5
Q

What are the common types of bacteria that cause native valve endocarditis? (4)

A

Staph aureusViridans streptococciEnterococcusStaph. epidermidis

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6
Q

What is the difference between bacteraemia and septicaemia?

A

Bacteraemia = presence of bacteria in the bloodSepcticaemia = multiplication of bacteria in the blood

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7
Q

How is bacteraemia/ septicaemia tested for?

A

Blood samples are taken and put in blood culture machines - this incubates the bottles at 37 degrees and detects the production of CO2 indicating growthIf CO2 is detected, the bottle is promptly removed and a small sample cultured and looked at under the microscope

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8
Q

What does the presence of bacteria in the blood usually indicate?

A

That there is a focus of infection elsewhere in the body (can be a skin contaminant)

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9
Q

What is infective endocarditis?

A

Infection of the endothelium of the heart valves

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10
Q

What are the categories of endocarditis based on time of onset?

A

AcuteSubacute (over weeks/ months)

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11
Q

What is the mean age of getting infective endocarditis?

A

Majority greater than 50 years old but can occur in children with congenital heart disease

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12
Q

Predisposing factors for endocarditis?

A

Heart valve abnormality e.g. calcification/ sclerosis in elderly, congenital heart disease, post rheumatic feverProsthetic heart valveiv drug usersIntravascular lines

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13
Q

How does endocarditis form?

A

Heart valve damage causes turbulent blood flow over roughened endotheliumPlatlets and fibrin are depositedBacteraemia occurs (may be very transient)Organisms settle in fibrin/ platelet thrombi becoming a microbial vegetationInfected vegetations are friable and break off becoming lodged in the next capillary bed they encounter causing abscesses or haemorrhage (can be fatal)

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14
Q

What side of the heart is usually affected by endocarditis?

A

Left side (mitral and aortic valves)

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15
Q

What are the unusual organisms causing endocarditis?

A

Atypical organisms (Bartonella, Coxiella burnetti, Chlamydia, Legionella, Mycoplasma, Brucella)Gram negativesFungi

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16
Q

What microorganism causes Q fever?

A

Coxiella burnetti

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17
Q

What are the usual presenting symptoms of acute endocarditis?

A

Overwhelming sepsisCardiac failure

18
Q

Symptoms of subacute endocarditis?

A

FeverMalaiseWeight lossTirednessBreathlessness

19
Q

Signs of subacute endocarditis?

A

FeverNew or changing heart murmurFinger clubbingSplinter haemorrhagesSplenomegalyRoth spots, Janeway lesions, Osler nodesMicroscopic haematuria

20
Q

What are Janeway lesions?

A

non-tender, small erythematous or haemorrhagic macular or nodular lesions on the palms or soles

21
Q

Roth spots?

A

A hemorrhage in the retina with a white center.

22
Q

What are osler nodes?

A

painful, red, raised lesions found on the hands and feet

23
Q

Diagnosis of endocarditis?

A

Take 3 sets of blood cultures (taken at different times at different sites before antibiotics are started)If blood culture negative, consider serology for atypical organismsEchocardiogram (transoesophageal more sensitive than transthoracic)

24
Q

What are the 2 different types of prosthetic valve endocarditis and what usually causes each?

A

Early (within 60 days of placement) = usually infected at time of valve insertion = staph aureus or staph epidermisLate = many years later valve insertion due to co-incidental bacteraemiaWide range of possible organisms

25
Q

Where is endocarditis in IV drug users usually seen?

A

In the right side - tricuspid valve

26
Q

What is the usual organism that causes endocarditis in drug users?

A

Staph aureus - often presents as a staph aureus “pneumonai” - this is usually secondary to the endocarditis

27
Q

Initial Antibiotics for native valve indolent (subacute) endocarditis?

A

IV amoxicillin and gentamicin

28
Q

Initial Antibiotics for native valve severe sepsis (acute) endocarditis?

A

Flucloxacillin

29
Q

Initial Antibiotics for prosthetic valve or suspected MRSA endocarditis?

A

Vancomycin + Rifampicin + gentamicin Valve replacement is usually required

30
Q

Initial Antibiotics for native valve endocarditis with risk factors for resistant pathogens?

A

VancomycinMeropenem

31
Q

Initial Antibiotics for endocarditis in drug users?

A

Flucloxacillin

32
Q

Antibiotics given when we known viridian’s streptococci is causing the endocarditis?

A

BenzylpenicillinGentamicin

33
Q

Antibiotics given when we know enterococcus is causing the endocarditis?

A

Amoxicillin/ vancomycinGentamicin

34
Q

Antibiotics given when we know staphylococcus epidermidis is causing the endocarditis?

A

VancomycinGentamicinRifampicin

35
Q

Treatment lengths for endocarditis?

A

IV antibiotics usually given for 4-6 weeksIf failing on antibiotic therapy, consider referral for surgery early

36
Q

When are prophylactic antibiotics used for endocarditis?

A

When patients with hear valve lesions, congenital heart defects or prosthetic heart valves are having GI or GU procedures if infection is suspected

37
Q

What is myocarditis?Age?Symptoms?signs?

A

Inflammation of cardiac muscleYounger peopleFever, chest pain, shortness of breath, palpitationsArrhythmiacardiac failure

38
Q

What is the main causes of myocarditis?

A

Usually enteroviruses e.g. Coxsackie A and B, echovirus, but other viruses possible e.g. influenza

39
Q

How is myocarditis diagnosed?

A

Viral PCRThroat swab and stool for enterovirusesThroat swab for influenzaSupportive therapy

40
Q

What is pericarditis?What does it often occur with?What is the main symptom?

A

Inflammation of pericardiumMyocarditisChest pain

41
Q

What is the main cause of pericarditis?

A

Viruses Can be caused by bacteria e.g. after cardiothoracic surgery

42
Q

How is pericarditis treated?

A

Supportive treatment unless bacterial cause (in which it needs antibiotics and drainage)

1st Year - Cardiology (25 decks)

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