Other Forms of Heart Disease Flashcards
Infection of normal valves with a virulent organism (S. aureus)
Acute bacterial endocarditis
Indolent infection of abnormal valves with less virulent organisms (S. viridans)
Subacute bacterial endocarditis
Organism suspected in endocarditis with intravenous drug users
MRSA, Pseudomonas
Organism suspected in prosthetic valve endocarditis
Staph epidermidis
Most common bacterial cause of endocarditis
Streptococcus viridans is the most common cause of endocarditis. It typically occurs as late complication of valve replacement and presents as small vegetations and embolic events.
Modified Duke criteria for diagnosis of infectious endocarditis
Definite: 2 major criteria, or 1 major + 3 minor criteria, or 5 minor criteria
Possible: 1 major + 1 minor criteria, or 3 minor criteria
Major clinical criteria of infectious endocarditis
- Positive blood culture: isolation of typical microorganism for IE from 2 separate blood cultures or persistently positive blood culture
- Single positive blood culture for C. burnetii or antiphase-1 IgG antibody titer >1:800
- Positive echocardiogram: presence of vegetation, abscess, or new partial dehiscence of prosthetic valve; must be performed rapidly if IE is suspected
- New valvular regurgitation (change in preexisting murmur not sufficient)
Minor criteria of infectious endocarditis
- Predisposing heart condition or IV drug use
- Fever ≥38.0°C (100.4°F)
- Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhage, Janeway lesions
- Immunologic phenomena: glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor (RF) Microbiologic evidence: positive blood culture, but not a major criterion (excluding single positive cultures for coagulase-negative staphylococci and organisms that do not cause endocarditis) or serologic evidence of infection likely to cause IE
Osler nodes (“osler” nodes = “ouch”)
Painful lesions on fleshy portions of extremities
Roth spots
Retinal hemorrhages
Janeway lesions
Cutaneous evidence of septic emboli
Splinter hemorrhages
Hemorrhages in fingernail beds
The first target of the echocardiography examination is the identification, characterization, and localization of masses consistent with valvular vegetation, the pathologic hallmark of endocarditis. What tool is considered the Gold Standard for diagnosis of valvular vegetation?
Transesophageal echocardiogram
Dental prophylaxis after endocarditis
2 g of Amoxicillin 30-60 minutes before procedure
Chest pain that is relieved by sitting and/or leaning forward
Acute pericarditis
