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DMST 367 Echo 3 > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

What does this image represent?

A

Olsen nodes and Janeway lesions

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2
Q

What does this image represent?

A

Aortic valve vegetation during diastole and systole

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3
Q

What doe we see with this image?

A

AV vegetation

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4
Q

What does this image represent?

A

AV vegetation doppler
1. Acute AI from the apex
2. Acute AI from abdominal aorta

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5
Q

What does this image represent?

A

Mitral vegetations during diastole and systole

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6
Q

What does this image represent?

A

MV vegetations

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7
Q

What does this image represent?

A

SBE on MV - quantify MR

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8
Q

What does this image represent?

A

Abscesses

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9
Q

What does this image represent?

A

AV endocarditis > MV > Perforation AML

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10
Q

What does this image represent?

A

MV/AV aneurysm in TEE

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11
Q

One reason why TTE has 40-80% sensitivity is because of what?

A

Shadowing

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12
Q

What is an embolus?

A

An unattached mass that travels through the bloodstream and is capable of creating blockages

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13
Q

What is an SOE?

A

Source of emboli: the source from which embolus originates

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14
Q

SOE is a common request to do what?

A

An echo

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15
Q

Emboli travel through the vascular system ending up where? 2

A
  1. Lungs (Pulmonary embolus/PE)
  2. Brain (stroke/TIA)
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16
Q

What is endocarditis?

A

A microbial infection which enters the bloodstream, typically confined to the endothelial lining of a valve, which may cause tissue destruction, and/or paravalvular abscess formation

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17
Q

How is a diagnosis for endocarditis made?

A

From a combination of clinical symptoms and positive blood cultures

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18
Q

What is a acute infections that causes endocarditis?

A

Staphylococcus aureus

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19
Q

What is a subacute infection that results in endocarditis? 3

A
  1. Streptococcus viridans
  2. Enterococci
  3. Much more
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20
Q

What are symptoms of infective endocarditis? 4

A
  1. CHF symptoms
  2. Flu like symptoms
  3. Chest pain
  4. Continuous murmur
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21
Q

What are signs of infective endocarditis? 5

A
  1. Fever unknown origins
  2. Blood cultures
  3. Underlying heart disease
  4. Stroke
  5. Pulmonary embolism
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22
Q

What is the clinical triad of infective endocarditis? 3

A
  1. Blood cultures
  2. Fever
  3. New murmur
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23
Q

Subacute bacterial endocarditis (SBE) is most commonly triggered by what infection?

A

Streptoccocus viridans

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24
Q

Subacute bacterial endocarditis usually affects what?

A

Previously diseased valves

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25
Q

What are the clinical signs for subacute bacterial endocarditis?

A

Sign’s of peripheral embolization

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26
Q

What are signs of peripheral embolization? 4

A
  1. Nail clubbing
  2. Roth’s spots
  3. Osler’s nodes
  4. Janeway lesions

Jorn

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27
Q

In terms of non-bacterial endocarditis, how thrombotic in nature are they?

A

Thrombotic in nature

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28
Q

What is non-bacterial endocarditis caused by? 2

A
  1. Cancers (maranitic endocarditis)
  2. Systemic diseases: Systemic lupis erythematosus
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29
Q

What is the typical description of non-bacterial endocarditis? 3

A
  1. Smaller
  2. Near the leaflet base where it attached to the wall
  3. Less independent
30
Q

What is Systemic lupis erythemoatosus?

A

Chronic inflammatory disease affect multiorgan systems

31
Q

What are some echo features of Non-bacterial endocarditis? 5

A
  1. Veggies
  2. PE
  3. MVP
  4. LV dysfunction (S+D)
  5. CAD
32
Q

What do we look for during an echo assessment for endocarditis?

A

Assess for predisposing valvular abnormalities

33
Q

What are some predisposing valvular abnormalities we look for during an echo assessment for endocarditis? 5

A
  1. Congenital defects
  2. Valvular prosthesis
  3. Intracardiac devices
  4. Heart failure
  5. New AV block
34
Q

Besides predisposing valvular abnormalities what is assessed for in terms of endocarditis in terms of echo assessment? 6

A
  1. Size
  2. Location
  3. # of vegetations
  4. Functional effects of the valve (regurg)
  5. Impact of valve dysfunction on LV size and function
  6. Other (paravalvular abscess)
35
Q

Where is endocarditis vegetation usually located?

A

Upstream from valve

36
Q

What is the mobility of endocarditis vegetation? 2

A
  1. Independent motion
  2. May prolapse through valve
37
Q

What is the texture of endocarditis vegetation?

A

Irregular

38
Q

How many sites of endocarditis vegetation are there?

A

Possibly multiple

39
Q

What are aortic valve vegetations?

A

Irregular shaped mobile mass attached to the LV side of the valve

40
Q

What is the size range of aortic valve vegetations?

A

Can range from undetectable to 3cm in length

41
Q

What is the best view to see aortic valve vegetations? 4

A
  1. PLAX
  2. PSAX
  3. A5C
  4. A3C
42
Q

Which leaflet(s) can AV vegetations affect at a time?

A

Can be bi/unicuspid

43
Q

Which valve is the most likely to be affected by endocarditis?

A

AV most likely with a bi/unicuspid AV involved 50% of the time

44
Q

What can AV vegetations be mistaken for? 4

A
  1. Calcified nodule
  2. Prosthetic valve
  3. Nodule of arantius
  4. Lambl’s excrescence
45
Q

What is nodule of arantius?

A

Normal thickening in central coaptation region

46
Q

What is something that is noticed with AV vegetation doppler? 2 (spectural)

A
  1. Steep deceleration slope of Ao
  2. Flow reversal in abdominal Ao
47
Q

What is the most common vegetation location?

A

Mitral valve

48
Q

Which MV is most affected with vegetation?

A

Atrial side of the MV

49
Q

What can happen with the atrial side of the MV with vegetation?

A

Prolapses into the LA during systole

50
Q

What is a particular risk of mitral vegetation?

A

MVP

51
Q

What is the DDX for mitral vegetations?

A

MYxomatous MV leaflet

52
Q

What are some consequences of mitral vegetations? 2

A
  1. Significant MR
  2. Can result in flail leaflet
53
Q

In terms of mitral valvular endocarditis, what leads to significant MR? 2

A
  1. LA dilation
  2. Elevated RV pressures
54
Q

What are some valvular endocarditis consequences of the aortic valve? 3

A
  1. LV dilation due to AI
  2. Interference with MV motion
  3. Also mild pericardial effusion and CHF
55
Q

What is tricuspid vegetation usually a result of? 2

A
  1. IVDU (intravenous drug use)
  2. Pacemaker wire infection
56
Q

What kind of process is tricuspid vegetations?

A

Acute process

57
Q

What can tricuspid vegetations result in?

A

Normal or abnormal valves

58
Q

What are the best views to see TV vegetations? 3

A
  1. PLAX
  2. RVIT
  3. PSAX base views
    However, we should confirm in other views as well
59
Q

How common are PV vegetations?

A

Less common

60
Q

How big are TV vegetations?

A

Generally large

61
Q

How mobile are TV vegetations?

A

Very

62
Q

What generally happens with TV vegetations?

A

Prolapse in RA

63
Q

What generally happens as a result of TV vegetation? 2

A
  1. Embolus of lungs
  2. May ruin valve, leading to severe TR
64
Q

What does bacterial infection generally do to the valves? 2

A
  1. Eat through tissue
  2. May also cause abscesses
65
Q

What do we do to assist in the diagnosis of vegetation with echo? 2

A
  1. Use colour to identify leak
  2. Use 2D zoom
66
Q

What are abscesses? and what are usually affected 2

A
  1. Infected areas adjacent to valve
  2. Usually aortic or mitral annulus affected
67
Q

Between TEE and TTE for detecting valvular endocarditis, which is more effective?

A

TEE is 97% effective vs TTE @ 80%

68
Q

Why is TTE so much less effective than TEE in terms of looking for vegetation?

A

TTE sensitivity increases with image quality and sonographer experience

69
Q

What is endocarditis treatment? 5

A
  1. Prevention
  2. Antimicrobial therapy
  3. Anticoagulation
  4. Afterload reduction
  5. Valve replacement or repair
70
Q

What are some afterload reduction durgs?

A

DIuretics

71
Q

How long would someone need to undergo antimicrobial therapy?

A

4-6 weeks

72
Q

What would be the prevention protocol for endocarditis?

A

Prophylactic antibiotics

DMST 367 Echo 3 (27 decks)

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