10. Infective Endocarditis

Question 1

Most common organisms that infective endocarditis

Answer 1

Staphylococci, streptococci, enterococci

Question 2

Risk factor for bacterial endocarditis

Answer 2

Prosthetic valves (coagulase -ve staph), cyanotic cong, health disease, IVDU, prev infective endocarditis

Question 3

Most common valve involvement

Answer 3

Mitral valve, aortic valve, tricuspid valve,pulm valve

Question 4

Sx of endocarditis

Answer 4

Malaise, fatigue, fever, anorexia, weight loss, muscle pains, abd pain if have septic emboli

Question 5

Clinical signs of endocarditis

Answer 5

Pyrexia, heart murmur, splenomegaly, nail ned infeacts, osler’s nodes, splinter haemorrhages, petecheal rash, janeway lesions

Question 6

IX for endocarditis

Answer 6

Routine bloods, 3 x 2 blood cultures, CXR, ECG, TTE, CT scan if worried about thrombolic events

Question 7

Modified duke major criteria

Answer 7

Major criteria- +ve blood culture (two separate blood cultures , or evidence of endocardial involvement on 3

Question 8

Suspicion of bacterial endocarditis

Answer 8

New heat murmur, febrile an evidence of CHD, new ECG conduction disturbance, new stroke, peripheral abscesses of unknown cause or unexplained embolic events, intravasc catheter related bloodstream infxn, febrile illness in IVDU- tricuspid valve endocarditis

Question 9

What to do if -ve blood cultures found

Answer 9

travel and animal exposure history as Q fever is cause- diagnose by serology

Question 10

Treatment for MRSA prosthetic valve

Answer 10

Vanco+ Rifampicin+ gent

Question 11

Strep endocarditis

Answer 11

Benzylpenicillin or ceftriaxone

Question 12

Enterococcus endocarditis treatment

Answer 12

Amox + gent or ceft

Question 13

Complications of endocarditis

Answer 13

Strokee, HF, Heart block