Endocarditis Flashcards

1
Q

What valve is MC infected?
-The exception is in IVDU. In this case, what valve is the MC infected?

A

Mitral overall

Tricuspid if IVDU

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2
Q

Acute Bacterial Endocarditis (infection of normal valve)
-MC organism

A

-Staph Aureus
–Also common in IVDU

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3
Q

Subacute (infection of abnormal valve)
-MC organism
-What is also associated with

A

-Strep Viridans
-Associated with poor dentition or dental procedures

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4
Q

IVDU-related MC organism involved

A

Staph Aureus (especially MRSA)

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5
Q

Prosthetic valve endocarditis
-Early (within 60 days) MC organism
-Late (after 60 days) MC organism

A

-Early: Staph epidermis
-Late: Staph Aureus

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6
Q

What organism causes endocarditis that is seen especially in men > 50 with a recent history of GI or GU procedure?

A

Enterococcus

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7
Q

What is the modified Duke Criteria, what do you need to diagnose as endocarditis, and what are the components of each category?

A

-You need 2 major OR 1 major + 2 minor

-MAJOR
–2 positive blood cultures by known organism
–Endocardial involvement (either + echo or new valvular regurgitation)
-MINOR
–Fever
–Predisposing condition (IVDU, abnormal valves, indwelling catheters)
–Vascular phenomena: Janeway lesions, pulmonary emboli
–Immunologic phenomena: Osler nodes, Roth spots, + Rheumatoid Factor, acute glomerulonephritis
– + blood culture with diff organism
– + echo not meeting major criteria (worsening murmur for example)

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8
Q

What are the common symptoms of endocarditis?

A

-Persistent fever (MC)
-New onset murmur or worsening or an existing murmur
-Roth spots: retinal hemorrhages with central clearing
-Osler nodes: painful nodules on pads of digits and palms
-Janeway lesions: painless macules on palms and soles
-Splinter hemorrhages: linear lesions under nail bed
-Splenomegaly
-Glomerulonephritis

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9
Q

How long do you treat a patient with ABX who has endocarditis?

A

4-6 weeks

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10
Q

Native Valve Treatment:

Prosthetic Valve Treatment:

Fungal Treatment:

A

-Nafcillin/Oxacillin + Ceftriaxone/Gentamicin
(Vanco if PCN allergic)

-Vanco + Gentamicin + Rifampin

-Amphotericin B (6-8 weeks)

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11
Q

What diagnostic studies should you be obtaining in a patient you suspect endocarditis?

A

-Blood cultures: 3 sets at least 1 hour apart
-ECG at regular intervals
-Transesophageal echocardiogram (TEE)

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12
Q

Name some patients who should get endocarditis prophylaxis and what procedures need it.

A

-Cardiac conditions: prosthetic heart valves, heart repairs (not including stents), prior history of endocarditis, congenital heart disease
-Procedures: Dental, Respiratory, Skin/MSK tissues (abscess drainage, etc.)

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13
Q

What are some options for prophylaxis for endocarditis?

A

Amoxicillin 2g 30-60 minutes prior to procedure

Clindamycin 600mg if PCN allergic

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14
Q

What type of endocarditis is associated with systemic lupus erythematosus (SLE)?

What is this?

A

Libman-Sacks Endocarditis

-Nonbacterial thrombotic endocarditis due to sterile platelet thrombi deposition on affected valve

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