CARDIOLOGY- INFECTIVE ENDOCARDITIS Flashcards
How many types of IE ?
Acute
-infection of previously normal heart valves
-infected by virulent oganism - Staphylococcus Aureus
-cured by surgery
Subacute
-infection of deformed valves
-infected by low virulent organism - Streptococcus viridans
-cured by antibiotics
What is internal risk factors of IE ?
-past history of IE
-pre-existing cardiac disease
-prosthetic heart valves
-intracardiac devices (pacemaker , ICD)
-congenital heart disease
What is the external risk factors of IE ?
Intravenous drug usage
Chronic venous access
Elder
Immunocompromised
What is the symptoms of IE ?
-fever
-night sweat
-chills
-fatigue
-poor appetite
-weight loss
-anemia
FEVER ESPECIALLY PROLONGED IS A WARNING SYMPTOMS
What is the extra cardiac signs you expect to see on the patient ?
Peripheral : finger clubbing , osler’s nodes , splinter hemorrhage , janeway lesion , petechiae, subconjunctival haemorrhage ,embolic lesions , roth spot
Abdominal : Hematuria , splenomegaly
Lungs : lung abscess
Neuro : stroke-like ,raised intracranial pressure signs (papillo edema )
What is the cardiac complication of IE ?
Valve rupture
Perivalvular abscess
What is the extra cardiac complication of IE ?
NALK
Neuro : stroke ,mycotic aneurysm
Abdomen : splenic abscess , liver abscess
Lung : Lung abscess
Kidney : Kidney injury with glomerulonephritis
To screen for the complications can use blood (FBC , Blood urea , LFT ) and CT (CT cardiac , CT lung , CT brain , CT abdomen)
What investigation you order to confirm the diagnosis of IE ?
Blood culture and sensitivity
-3 sets , 30minutes apart
-aerobic + anaerobic per set
-10mls of blood per bottle
-if negative but still suspecting IE -do PCR
what is the possible causes of negative result ?
-the patient might be partially treated , or the organism minght be fastidious such as fungal
What other investigation you want to order to diagnosing IE ?
What suggestive findings you expect ?
What is negative ?
Radiological
- vegetation , abscess
-if negative : repeat 1st week if 1st scan is negative
What is the major criteria of Duke’s criteria
-Blood culture positive
-Echocardiographic identification
-New valvular regurgitation
What is the minor Duke Criteria ?
-IVDU
-fever
-vascular lesions ( jane way lesions ..)
-immunological phenomena (osler nodes , roth spot)
How you want to confirm your dignosis using Duke’s Criteria ?
2 major
or
1 major + 3 minors
or
5 minors
If fever persists 7-10 days , what could be happening ?
-inadequate antibiotic dose
-resistant organism
-HAI
