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CV <3 > Lecture 7 Part 1: Endocarditis > Flashcards

Lecture 7 Part 1: Endocarditis Flashcards

1
Q

In what layer of the heart are the valves and vessels located?

A

Endocardium

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2
Q

For infective endocarditis to occur and actually affect a valve, what conditions generally need to be present?

A
  • Valvular damage/abnormality
  • OR
  • Turbulent blood flow
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3
Q

What is the MC route for IE to occur?

A

Oral

  • Dental extraction/surgery
  • Chewing candy
  • Tooth brushing
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4
Q

Where does IE tend to occur in hearts? What is the exception?

A
  • Mainly on the left-side.
  • Exception: IV drug users (IVDU)

Direct injection goes straight to the right side first. TV is also the most common among IVDU as a result.

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5
Q

What is a kissing valve infection?

A

Both valves infected, i.e. mitral valve and aortic valve.

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6
Q

What is the MC causative organism in native valve IE?

A

Staph Aureus

2nd is streptococcus

MC bacteria in the mouth and skin as well.

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7
Q

For a prosthetic valve, what are the most common causative organisms?

A
  • If prior to 2 months, staph is MC.
  • If post 2 months, strep is MC.

A is before R, so STA before STR

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8
Q

For IVDU, what is the MC causative organism for IE?

A

Staph, specifically affecting the TV.

Followed by strep (viridans) and enterococci.

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9
Q

For nosocomial IE, what is the MC causative organism?

A

Staph aureus

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10
Q

In what demographic is fungal IE MC in?

A

IVDU or ICU patients receiving broad-spectrum abx.

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11
Q

What is the MCC of death for patients with IE?

A

Heart failure

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12
Q

What is the common clinical presentation of IE?

A
  • Fever (90%)
  • Chills
  • Weakness
  • SOB
  • Night sweats

AKA all constitutional symptoms.

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13
Q

What are the most common conditions present in someone with IE?

A
  1. Heart murmurs (unless IVDU)
  2. CHF
  3. Septic emboli
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14
Q

What are the common physical exam findings for IE?

A
  • Murmurs
  • Petechiae
  • Splinter hemorrhages
  • Janeway lesions
  • Osler nodes
  • Roth spots
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15
Q

What is a Janeway lesion vs an Osler node?

A

Janeway lesion: PAINLESS patches on palms or soles, caused by staph.

Osler node: PAINFUL nodules on pads of fingers/toes, caused by vasculitis. MC: strep.

Probably know that jane is a painless staph.

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16
Q

What are Roth spots?

A
  • Oval, pale, retinal lesions surrounded by hemorrhage caused by vasculitis.
  • Usually chronic
  • MC: Strep
17
Q

What is the MC neurologic manifestation that may occur due to IE?

A

CVA

18
Q

For bacteremia, what is the procedure for blood cultures?

A
  1. 3 sets of cultures from different sites
  2. First and last samples must be drawn at least 1 hr apart.

Need prior to initiation of ABX

Only need to get 1 set before starting ABX.

19
Q

When might a TEE be preferred over TTE?

A

TEE would be preferred if the vegetation is small and/or large body habitus.

20
Q

What are the major Duke Criteria?

A
  • Blood culture positive
  • Endocardial involvement on echo (including new murmur)
21
Q

What are the minor Duke criteria?

A
  • Fever > 38C
  • Immunologic phenomena
  • Vascular phenomena
  • Echocardiography minor criteria ELIMINATED
  • Predisposition
  • Microbiologic evidence

FIVE PM

22
Q

What is the Duke criteria mnemonic?

A
  • Blood culture positive
  • Endocardial involvement
  • Fever > 38C
  • Immunologic phenomena
  • Vascular phenomena
  • Echocardiography minor criteria ELIMINATED
  • Predisposition
  • Microbiologic evidence

BE FIVE PM

23
Q

What is required for a definitive diagnosis of IE via Duke criteria?

A
  • 2 major
  • 1 major + 3 minor
  • 5 minor
24
Q

What is required for a possible diagnosis of IE via Duke criteria?

A
  • 1 major + 1 minor
  • 3 minor
25
Q

For native valve IE, what is the first-line abx?

A
  • Pen G + gent, but Vanco for the big boys

penguins gentleman

26
Q

For IVDU IE, what are the first-line abx?

A
  • Nafcillin
  • Gent
  • Vanco
27
Q

For prosthetic valve IE, what are the first-line abx?

A
  • Vanco
  • Gent
  • Rifampin
28
Q

For Fungal IE, what is the first-line abx?

A

Amphotericin B

Still need sx!

29
Q

What surgery is used for IE management?

A

Open sternotomy valve replacement, repair, or debridement.

30
Q

When is surgery indicated for IE?

A
  • Refractory CHF (MCC for early sx)
  • Fungal IE
  • Sepsis post 72 hrs of abx
  • Recurrent septic emboli after 2 wks of abx
  • Rupture of aneurysm of sinus of Valsalva
  • Conduction disturbances 2/2 septal abscess
  • Kissing infection of anterior mitral leaflet and aortic valve.
31
Q

What is a common evaluation we should consider to help prevent people who are at risk of IE?

A

Dental evals!

32
Q

What oral disease is the MCC of spontaneous bacteremia?

A

Gingivitis

33
Q

What kind of patients are at high risk for IE and should be prophylaxed?

A
  • Prosthetic valves
  • Prior endocarditis
  • Cyanotic CHD
  • Cardiac transplantation patients with valvulopathy
34
Q

What procedures need endocarditis prophylaxis?

A
  • Dental procedures
  • Respiratory tract procedures
  • Procedures on infected skin or MSK tissue.

NO MORE GI/GU prophylaxis

35
Q

What are the preferred abx for endocarditis prophylaxis?

A
  1. Axoxicillin
  2. Clinda/keflex/azithro/claritho (for PCN allergy)
  3. Ampicillin IM
  4. Cefazolin/rocephin IM

Usually about 1 hour prior to the procedure.

Example: 4 tabs of amoxicillin 500mg 1 hour prior to dental procedure

36
Q

How do we diagnose IE and how long is tx?

A
  • Duke’s criteria for diagnosis
  • 6 week treatment!

CV <3 (25 decks)

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