S13C150 - Infective Endocarditis

Question 1

Valves affected in frequency order

Answer 1

• mitral most common

- then Ao, tricuspid, pulmonic

Question 2

Risk factors for IE

Answer 2

-structural abnormalities, IVDU, indwelling catheters, poor dental hygien, HIV
=rhemuatic heart dz
-MVP

Question 3

Valve predilection in IVDU

Answer 3

-tricuspid

Question 4

T/F: No difference for risk of IE b/w mechanical and bioprosthetic.

Answer 4

true, no difference

Question 5

Bugs in IE:

Answer 5

• staph aureus most common
• coagulase-negative staphylococcus
• strep viridans
• other strep
• enterococcu
• HACEK
• fungus

Question 6

HACEK

Answer 6

• haemophilus
• actinobacillus
• cardiobacterium
• eikenella
• kingella

Question 7

Cardiac Complications in IE

Answer 7

• CHF
• rupture of chordae tendinae or papillary muscle
• perforation of cardiac chamber
• valvular abscesses
• pericarditis
• heart blocks
• arrhythmias

Question 8

Cutaneous signs of IE

Answer 8

• petechiae
• splinter or subungual hemorrhages of nails
• osler nodes (small, tnder nodules on pads of digits, last hours to days)
• janeway lesions: small hemorrhagic painless plaques on palms and soles

Question 9

Dx of IE: duke criteria

Answer 9

-Major:
Positive blood culture x2
Echocardiogrpahic involvement (oscillating intracardiac mass, abscess, dehiscence of prosthetic valve), new regurgitaiton

-Minor
Predispoisiton
Fever
Vascular phenomena (arterial emboli, conjunctival hemorrhage, janeway lesion)
IMmune phenomena (glomerulonephritis, osler nodes, roth spots, rheumatoid fever)
Microbio evidence that doesn’t fit in major
Echo findings

Question 10

Tx or IE

Answer 10

• uncomplicated hx: CTX 1-2g IV or vanco or tobramycin
• IVDU/congenital dz/MRSA/already on oral Abx: nafcillin PLUS gentamicin PLUS vanco
• Prosthetic heart valve: vanco plus genta plus rifampin

Question 11

Patients who require IE prophylaxis (according to AHA):

Answer 11

• prosthetic heart valves
• prosthetic matieral used for valve repair
• history of previous IE
• heart transplant with abnormal valve fxn

-congenital heart defect including:
cyanotic heart dz not repaired,
defect that been repaired with prosthetic material or a device for 1st 6m after repair,
repaired dz with residual defects

Question 12

Procedures requiring IE prophylaxis and what to give:

Answer 12

-dental: amoxicillin 2g PO 30-60min prior to procudure
or ancef or keflex or clinda or azithro

-skin: dicloxacillin or keflex 2g PO 30-60min before, or vanco or clinda