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Cardio HighYields > Valvular - Infective endocarditis > Flashcards

Valvular - Infective endocarditis Flashcards

1
Q

which patients require IE prophylaxis?

A

see pic PLUS

  • prosthetic valves
  • previous IE
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2
Q

What procedures require IE prophylaxis?

A

see pic.

included is bronchoscopy with biopsy

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2
Q

as per 2023 ESC guideline on IE, the followings does not routinely need antibiotic prophylaxis. (but may consider in individual basis)

A

Patients at intermediate risk of IE include those with:

(i) rheumatic heart disease (RHD);

(ii) non-rheumatic degenerative valve disease;

(iii) congenital valve abnormalities including bicuspid aortic valve disease;

(iv) cardiovascular implanted electronic devices (CIEDs); and

(v) hypertrophic cardiomyopathy.

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2
Q

procedures that does not require IE prophylaxis

A

-bronchoscopy without biopsy
- GI and GU procedures

but in the recent, 2023 ESC IE guideline, it is class IIb

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3
Q

Drugs for IE prophylaxis

A
  • amoxicillin
  • azithromycin
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4
Q

CHD that does not require IE Prophylaxis

A
  • ASD
  • VSD
  • PDA
  • BAV
  • CoA
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5
Q

Risk factors to develop IE

A

regurgitant valve lesions
CHD
prosthetic valve
dental infection
implantable cardiac device
immunocompromised state

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6
Q

ideally blood culture for IE

A
  • 2-3 sets, 6 hours apart
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7
Q

when to do TEE for IE

A
  • non-diagnostic TTE
  • complications suspected or intracardiac lead present
  • Staph, enterococcus or fungal infection
  • Prosthesis + presistene fever
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8
Q

What is Definite IE by Pathological criteria

A

Microorganisms demonstrated by results of cultures or histologic examination of a vegetation, a vegetation that has embolized, or an intracardiac abscess specimen; or

  • Pathologic lesions, vegetation, or intracardiac abscess confirmed by results of histologic examination showing active endocarditis
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9
Q

What is Definite IE and Possible by Clinical criteria

A

DEFINITE IE
- 2 major
- 1 major + 3 minor
- 5 minor

POSSIBLE IE
- 1 major + 1 minor
- 3 minor

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10
Q

What is rejected IE criteria

A

4 criteria

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11
Q

What are major criteria in modified duke’s criteria

A

2 major criteria

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12
Q

What are minor criteria in modified duke’s criteria

A

6 criteria

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13
Q

Vascular phenomena: painless lesion on palms and soles

A

janeway lesions

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13
Q

Vascular phenomena in the conjunctiva

A
  • conjunctival hemorrhage
  • subconjunctival hemorrhage
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13
Q

Vascular phenomena: leads to vascular dilatation

A
  • Mycotic aneurysm
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14
Q

Vascular phenomena: in the finger

A

Splinter hemorrhages
- should on proximal rather than distal

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15
Q

Vascular phenomena: emboli

A

sample, see pic

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16
Q

Immunological Phenomena: painless nodules on fingers and toes

A

Osler nodes

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16
Q

Complications with IE: local complications

A

Valvular destruction
perivalvular extension

17
Q

Immunologic phenomena: exudative lesions in retina

A

Roth Spots

18
Q

Complications with IE: systemic complications

A
  • metastatic spread of infection
  • embolic
19
Q

Complications with IE: immunologic complications

A
  • osler nodes
  • roth spot
  • glomerulonephritis
  • (+) rheumatoid factor
20
Guideline for the use of anticoagulation in IE
- do not start anticoagulation due to hemorrhagic conversion in stroke patient - even in mechanical prostheses - STOP the warfarin!
21
who requires surgical management in patient with IE? AHA
see pic class I - valve dysfunction with HF - valve destruction - Left sided staph ot fungal infection - persistent Bacteremia or fever ≥ 5 days
22
who requires surgical management in patient with IE? Braunwald
check the table
23
IE with intracardiac device, do you need to take it out?
yes!
24
management for Right sided IE: medical and surgical intervention
see pic
25
risk factors to develop CIED
- Pocket hematoma - strongest risk factor
26
in CIED, when might the device remain?
see pic
27
after how many days can you re-implant a new device for CIED?
negative blood culture and after 72hrs after device removal
28
question?
no prophylaxis needed GI and GU procedures - do not require prophylaxis
29
question
stop the warfarin. no need to bridge heparin
30
question?
2
31
role of echo in IE
- Early - Monitoring during therapy - intraop - after therapy completion
32
what is "echocardial involvement" as part of the major criteria in modified dukes for IE?
- vegetation - paravalvular abscess, pseudoaneurysm, intracardaic fistula - New regurgitation (perforation) - Dehiscence of prosthetic valve
33
Detection of vegetation: TTE vs TEE
for native valve, specificity with TTE and TEE
34
Detection of vegetation: when to use TTE vs TEE
all suspected IE, TTE as initial evaluation
35
when is TTE alone enough in IE?
negative initial TTE and the clinical suspicion is low then no need to proceed with TEE
36
differential diagnosis for mobile endocardial echodensity
think of this 8 differentials
36
Characteristics of vegetation in terms of MOTION
36
Characteristics of vegetation in terms of EFFECTS
37
Characteristics of vegetation in terms of LOCATION
38
Characteristics of vegetation in terms of TEXTURE and SHAPE
39
40
include prolongation of conduction system (ECG)
41
question
not a dilated coronary sinus - it does not expand in systole consider ->mitral anular pseudoaneurysm
42
Predictors for embolization in IE: echo predictors
- vegetation >10mm size - highly mobile vegetation - Anterior MVL location
43
INdication for EARLY SURGERY for IE?
- Valve dysfunction causing HF - IE caused by staph, fungal or other highly resistant organisms - Complications of heart block, annular or aortic abscess or penetrating lesions - Persistent infection (bacteremia or fever ≥5days on antibiotic
44
when to do CT. Cardiac MRI or FDG PET/CT in IE?
see pic
44
When is the best possible time to do TTE in suspected IE?
<12 hrs after initial evaluation

Cardio HighYields (24 decks)

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