Week 5 - Infective Endocarditis and Rheumatic Heart Disease

Question 1

What is infective endocarditis?

Answer 1

infection of endocardium

Question 2

What causes infective endocarditis?

Answer 2

almost always bacteraemia or septicaemia spread to endocardium

Question 3

What is the pathophysiology of infective endocarditis?

Answer 3

infection injures and inflames heart, causing vegetations of platelets, fibrin and microorganisms. these can embolise.

Question 4

What conditions predispose an individual to infective endocarditis?

Answer 4

prosthetic valves,
cardiac devices,
IV drugs,
rheumatic valve disease,
mitral valve prolapse,
immunosuppression

Question 5

How may infective endocarditis present?

Answer 5

may present as a result of embolised vegetations - MI, syroke, pulmonary embolism, vegetation on valves,

Question 6

What are symptoms of infective endocarditis?

Answer 6

fever, chills, poor appetite, weight loss, heart murmur

Question 7

What manifestations are associated with infective endocarditis? (4)

Answer 7

• cutaneous - janeway lesions on palms, and osler nodes on fingers and toes
• roth spots
• splinter haemorrhage on nails

Question 8

How do you diagnose infective endocarditis?

Answer 8

• 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

Question 9

What bacteria commonly causes infective endocarditis?

Answer 9

staph aureus, strep, enterococci or coagulation negative staph. if rarer bacteria, make sure to do specific tests to diagnose.

Question 10

Which criteria is used to make an official diagnosis of infective endocarditis?

Answer 10

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].

Question 11

How do you determine the prognosis of infective endocarditis?

Answer 11

• 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

Question 12

How do you treat infective endocarditis?

Answer 12

antibiotics. weeks.

Question 13

How do you treat infective endocarditis caused by strep or staph aureus?

Answer 13

• strep - penicillin +/- vancomycin
• staph aureus - flucloxacillin and sometimes vancomycin
• in penicillin allergy, vancomycin and gentamycin

Question 14

How long is the treatment with antibioics

Answer 14

4 weeks. up to 6 weeks with prosthetic valve

Question 15

How do you treat infective endocarditis when prosthetic valve is present?

Answer 15

ampicillin, flucloxacillin and gentamycin. up to 6 weeks

Question 16

What are indications for cardiac surgery following infective endocarditis?

Answer 16

valve issue typically cause infective endocarditis
- ongoing HF despite antibiotics.
- uncontrolled persistent infection with positive cultures.
- if risk that vegetation could embolise.

Question 17

What is the pathophysiology of rheumatic heart disease?

Answer 17

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

Question 18

What is the natural history of rheumatic heart disease?

Answer 18

many patients asymptomatic. when symptoms appear usually its severe - dyspnoea and HF symptoms

Question 19

How do you diagnose RHD?

Answer 19

dyspnoea and HF symptoms.
commonly AF.
CXR - pulmonary oedema
echo - valve issues

Question 20

How do you treat rheumatic fever?

Answer 20

• prophylaxis - avoid rheumatic fever
• if diagnosed, secondary prophylaxis -use penicillin, maybe for years,

Question 21

How do you treat RHD?

Answer 21

• diuretics,
• vasodilators,
• treat AF,
• treat MS percutaneous intervention.
• surgery for severe valve issues