Endocarditis

Question 1

• Infection of the endocardium (inner lining of heart chambers and valves)
• occurs when bacteria (or fungal infection) spreads through the bloodstream and attaches to damaged areas in the heart
• morbidity and mortality are high
• should be suspected if an abnormal murmur in present is present in patients with a fever or compelling history

Answer 1

endocarditis

Question 2

Risk factors for endocarditis?

Answer 2

Native valve disease (often caused by streptococcal or staphylococcal species)

• Bicuspid aortic valve, mitral valve prolapse, regurgitant lesions, hypertrophic cardiomyopathy

prostethic valve
congenital heart disease
IV drug use
indwelling catheter
previous endocarditis

Question 3

signs/ symptoms of endocarditis

Answer 3

Symptoms
* fever
* malaise
* weakness
* arthralgias
* weight loss

Signs

• cardiac murmur (usually regurgitant
• AV conduction abnormalities
• heart failure from valvular regurgitation
• embolic manifestations

Question 4

what should you get if you suspect endocarditis?

Answer 4

2 separate blood cultures

Question 5

management of endocarditis?

Answer 5

• antibiotic therapy guided by causative organism
• emergent valve repair/replacement is indicated in patients with hemodynamic instability
• early surgical intervention considered
• valve destruction
• paravalvular abscess
• heart block
• large vegetations
• recurrent septic emboli

Question 5

what is the role of echo in endocarditis?

Answer 5

• essential role in diagnosis
• identifies predisposing heart disease
• detect complication
• assess hemodynamic consequences
• serial evaluation
• establish prognosis

Question 6

what are physical exam findings you might see in endocarditis?

Answer 6

oslers’s nodes

• Tender, s/c nodules

Janeway lesions

• Nontender erythematous, haemorrhagic or pustular lesions often on palms or soles