11 17 2014 Endocarditis Flashcards Preview

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Flashcards in 11 17 2014 Endocarditis Deck (11)
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Mecahism by which injury leads to valve vegetation formation

Endothelial injury usually occurs due to turbulent blood flow resulting from a pre-existing valvular disease


Endothelial injury may also occur due to foreign material within circulation-- venous catheters/ prosthetic heart valves


Once endothelial surface is exposed, platelets adhere to collaged and initiate the formation of a sterile thrombus  -- Nonbacterial thrombotic endocarditis (NBTE)


List the common pathogens that cause infection for endocarditis

1. Staphylococci Aureus  ( more virulent)

2. Streptococci ( specifically Viridans)

3. HACEK bacteria:  Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella)

- oral cavity

4. Acute Rheumatic Fever : Group A beta-hemolytic stretpococcal infection (GABH) -- starts as pharyngitis


Note that in a rural area with not IV drug users, Strep Viradans infection is greater than staph aureus


Mechanism for infections endocarditis

Formation of thrombus ( NBTE -- nonbacterial thrombotic endocarditis) is caused by endothelial injury that caused platelets to aggregate and form a sterile thrombus through fibrin deposition.


Fibrin-platelet deposit = surface of adherence by bacteria.

Fibrin then covers organisms and protects them from host defenses by inhibiting chemotadis and migraiton of phagocytes


Acute Endocarditis Clinical Presentation:

Acute onset of high-grade fever and shaking chills

Rapid onset of Cardiac Heart failure due to structural damage

      - rapid valve failure

HIghly virulent organism attacking a normal valve

* Cerebellar complications -- large mobile and on mitral valve


High morbidity and mortality even with appropriate therapy/surgery


Subacute endocarditis Clinical Presentation

Low grade fever with non-specific fatigue, anorexia, weight loss, and "flu-like" symptoms

* fever may be absent in elderly


Less virulent organims but also happens due to an already abnormal valve

* Aortic valve (most common),  Mitral valve (2nd common)

Tricuspid Valve ( tricuspid regurgitation) -- IV drug users


Endocarditis is assumed to be correct diagnosis (until proven otherwise) when what two criteria are present?

New regurgitant murmur + Recurrent/ unremitting fever


Clinical Features of infectious Endocarditis -- physical findings

1. Osler nodes: painful fingertip nodules

2. Janeway Lesion : painless palm or sole erythematous lesion

3. Splinter Hemorrhages: petechia nail bed

4. Roth Spots:  Retinal hemorrhage

4. 90% of patients have a murmur



Rheumatic Fever Clinical features:

1. who does it affect?

2. when does it present?


2-3 weeks after streptococcal infection


Rheumatic Fever major criteria:


J-  Joints : polyarthritis : swelling, redness, warmth, tenderness

O-- carditis -- aortic or mitral regurgitation

N--Nodules (subcutaneous)

E-- Erythema marginatum

S-- Sydenham chorea: uncoordinated involuntary purposeless movements

- patient cannot maintain clenched fists


Rheumatic fever minor criteria:


C-- CRP increased 

A-- Arthralgia

F-- Fever

E-- Elevated ESR

P -- Prolonged PR interval

L-- Leukocytosis


What are the requirements needed to diagnose RF?

2 major criteria 


1 major criteria and 2 Minor criterias


* throat culture and take blood titers of antibody.  ** GO WITH BLOOD TITERS**

Recall that patients come 2-3 weeks after suffering from RF -- may no longer be in throat