Endocarditis Flashcards
What is endocarditis?
bacterial infxn on the heart valve
What % is nosocomial?
30-35%
What are the RF for nosocomial?
- 60yo+
- male
- IV drug use
- dental
What are the comorbidities?
- structure of heart: valvular dz (aortic stenosis/mitral regurg)
- rheumatic fever
- congenital heart dz
- prosthetic heart valve
What are the bugs?
- strep viridans (comm)
- staph aurues (health): most common b/c its in the hosp compared to healthy people
What are slow growing bacteria and hard to distinguish?
- HACEK
- Fungi
What is the pathophsiology?
turbulent blood flow –> damage to endocardium –> platelet and fibrin are hanging out and blocking WBC form getting to bacteria (NBTE) –> tissues get destructed –> embolization
What structures are affected?
- valves
- chordea tendinae
- interventricular septum
- mural endocardium
What is acute?
- toxic presentation/sick
- days~wks
- valve destruction
- happens on normal valves (in the hospital) –> staph aureus
What is subacute?
- mild toxic
- wks ~ months
- abnormal valves (normal people that realize later) –> strep viridans
PE of acute?
- fever/chills
- SOB
- pleuritic chest pain
- myalgias
- kidneys get affected (b/c they receive 22%) –> back pain
- abdominal pain b/c spleen gets affected
- JANEWAY LESIONS
PE of subacute?
- nonspecific (fever, anorexia, wt loss)
- specific: OSLER NODES (no blanch/clusters)
PE for BOTH?
-fever
-murmurs
-HF
skin lesions:
-petechiae
-splinter hemorrohages
-roth spots
Dx?
1) Hx and PE
2) Blood cultures
3) echocardiogram
Other labs?
- ESR/CRP
- UA
- ECG
