Week 5 - Infective Endocarditis and Rheumatic Heart Disease Flashcards
What is infective endocarditis?
infection of endocardium
What causes infective endocarditis?
almost always bacteraemia or septicaemia spread to endocardium
What is the pathophysiology of infective endocarditis?
infection injures and inflames heart, causing vegetations of platelets, fibrin and microorganisms. these can embolise.
What conditions predispose an individual to infective endocarditis?
prosthetic valves,
cardiac devices,
IV drugs,
rheumatic valve disease,
mitral valve prolapse,
immunosuppression
How may infective endocarditis present?
may present as a result of embolised vegetations - MI, syroke, pulmonary embolism, vegetation on valves,
What are symptoms of infective endocarditis?
fever, chills, poor appetite, weight loss, heart murmur
What manifestations are associated with infective endocarditis? (4)
- cutaneous - janeway lesions on palms, and osler nodes on fingers and toes
- roth spots
- splinter haemorrhage on nails
How do you diagnose infective endocarditis?
- infection so most signs will be in bloods signs of infection.
- use Echo if positive bacterial cultures present
- use CT/MRI to look at valves and masses.
- use FDG PET CT for signs of inflammation - high metabolic activity
What bacteria commonly causes infective endocarditis?
staph aureus, strep, enterococci or coagulation negative staph. if rarer bacteria, make sure to do specific tests to diagnose.
Which criteria is used to make an official diagnosis of infective endocarditis?
duke criteria. looks at major and minor criteria of symptoms. Need [2 major criteria] or [1 major and 3 minor criteria] or [5 minor criteria].
How do you determine the prognosis of infective endocarditis?
- patient characteristics (like age and co-morbidities)
- infecting microorganism
- presence of cardiac-non cardiac complications (HF, renal failure, ischaemic stroke)
- echo findings - severity of valve disease or systolic dysfunction
How do you treat infective endocarditis?
antibiotics. weeks.
How do you treat infective endocarditis caused by strep or staph aureus?
- strep - penicillin +/- vancomycin
- staph aureus - flucloxacillin and sometimes vancomycin
- in penicillin allergy, vancomycin and gentamycin
How long is the treatment with antibioics
4 weeks. up to 6 weeks with prosthetic valve
How do you treat infective endocarditis when prosthetic valve is present?
ampicillin, flucloxacillin and gentamycin. up to 6 weeks
What are indications for cardiac surgery following infective endocarditis?
valve issue typically cause infective endocarditis
- ongoing HF despite antibiotics.
- uncontrolled persistent infection with positive cultures.
- if risk that vegetation could embolise.
What is the pathophysiology of rheumatic heart disease?
strep b-haemolytic group a at age 5-15yrs. 2/3 weeks later if untreated may lead to rheumatic fever. inflammation of heart and joints. after years may develop into rheumatic heart disease
What is the natural history of rheumatic heart disease?
many patients asymptomatic. when symptoms appear usually its severe - dyspnoea and HF symptoms
How do you diagnose RHD?
dyspnoea and HF symptoms.
commonly AF.
CXR - pulmonary oedema
echo - valve issues
How do you treat rheumatic fever?
- prophylaxis - avoid rheumatic fever
- if diagnosed, secondary prophylaxis -use penicillin, maybe for years,
How do you treat RHD?
- diuretics,
- vasodilators,
- treat AF,
- treat MS percutaneous intervention.
- surgery for severe valve issues
