Infective Endocarditis

Question 1

infective carditis def

Answer 1

serious infxn of the endocardial surface on a valve

Question 2

1/3 endocarditis caused by

Answer 2

nosocomial sources

Question 3

endocarditis risk factors

Answer 3

old men who abuse IV drugs with bad teeth

Question 4

comorbid conditions of endocarditis

Answer 4

• mitral regurgitation & aortic stenosis&raquo_space; valvular dz
• congenital >Patent Ductus Arteriosus/Ventricular Septal Defect
• Rheumatic Heart dz (strep throat)&raquo_space; travels to <3 via lymph system causes attacks

Question 5

buggy culprits of endocarditis

Answer 5

1. Staph aureus MRSA» nosocomial
2. Strep veridans&raquo_space; community acquired&raquo_space;teeth
3. Staph aureus&raquo_space; IV drug users&raquo_space; tricuspid valve

Question 6

pathophys of endocarditis

Answer 6

turbulent blood flow»damage to endocardium»platelet aggregation & fibrin deposition&raquo_space; thrombi»bacteremia adherence & colonization w/in thrombus»mature vegetation»eats tissue (protected on top by thrombus, eats downwards on tissue)»tissue destruction»embolization»leading to heart failure 2* to regurgitation/valve destruction

Question 7

affected structures of endocarditis

Answer 7

valves
chardae tendinea
interventricular septum
mural endocardium

Question 8

acute endocarditis

Answer 8

otherwise healthy w/ nml heart valves to very sick quickly
usually Staph aureus» toxic presentation
progressive valve destruction & metastatic infxn
caused by massive bacterial exposure or invasive card surgery

Question 9

subacute endocarditis

Answer 9

fever, wt loss & chills
strep veridans (low virulence)
typically started w/ abnml heart valves» allows typically noninvasive bugs to take hold
rarely leads to metastatic infxn

Question 10

other consideration when making your dx

Answer 10

community acquired vs nosocomial
native vs prosthetic valves
source of infxn&raquo_space; iv drugs, teeth, hosp stay.

Question 11

acute endocarditis presentation

Answer 11

roth spots in the eyes&raquo_space;specific
Osler’s nodes (painful micro emboli)&raquo_space; specific
Janeway lesions (not painful micro emboli)&raquo_space; specific

petichiae
splinter hemorrhages

Question 12

Osler nodes

Answer 12

subacute endocarditis
painful purple nodules found in pulp of fingers/toes
micro-abscess w/ bacteria seeded in the emboli
later findings (heart thrombi needs to be large enough to throw clots)

Question 13

Janeway lesions

Answer 13

acute endocarditis
painless, macular, erythematous lesion on palms/soles
later findings (heart thrombi needs to be large enough to throw clots)

Question 14

Roth spots

Answer 14

exudative edematous hemorrhagic lesions of retina

flame shaped hemorrhages w/ pale center

Question 15

Dx of endocarditis

Answer 15

H&P
Blood Cx x 3 from different sites over 24hrs (ideal)
Echocardiograph&raquo_space;transthoracic#1, transesophageal #2

Question 16

Duke Criteria

Answer 16

know that it exists, look it up when you’re a provider

Question 17

Tx of endocarditis

Answer 17

-empirical antibiotics x 2-6 weeks
vancomycin + gentamicin (broad spectrum, bactericidal) pending blood Cx (then you’d narrow treatment

-Surgery>> 
to prevent emboli spread
heart failure by valve d/fxn, 
prosthetic valve infxn, 
failing medical management

Question 18

complications of endocarditis
typically from staph
embolization, metastatic infxn leads to:

Answer 18

1. neuro» stroke, hemorrhage, infxn
2. cardiac&raquo_space; valvular damage, HF, abscess, pericarditis, conduction d/order
3. renal»infacts, glomerulonephritis
4. musculoskeletal» septic arthritis, ischemia of extremities

Question 19

procedures requiring prophylaxis

Answer 19

dental procedures

Question 20

prevention of endocarditis

Answer 20

prophylaxis for high risk patients:

1. prosthetic heart valves
2. congenital heart defect
3. prior endocarditis