Lec 13 Valvular Heart Disease III

Question 1

What is infectious endocarditis?

Answer 1

infection of heart’s endocardial surface = most commonly happens in leaflets where high frictional stress develops

Question 2

What is acute IE?

Answer 2

affects normal heart valves
rapid destruction
large vegetations that can get dislodged and become septic emboli

if not treated = fatal w/in 6 wks

Question 3

What causes acute IE?

Answer 3

staph aureus usually = high virulence

Question 4

What is subacute IE?

Answer 4

affects damaged heart valves
develops slowly over days/mos
fatal by one yr if not treated

Question 5

What causes subacute IE?

Answer 5

strep viridans usually = low virulence

Question 6

What should you think someone goes to dentist and comes back with low grade fever that develops over wks?

Answer 6

likely subacute IE due to strep viridans

pt probably has some underlying problem with valve, congenital, rheumatic heart disease, etc

Question 7

What is pathogenesis of infectious endocarditis?

Answer 7

turbulent blood flow –> thrombus forms at site of injury –> bacteria enters circulation –> bacteria adheres to injured endocardial surface

Question 8

What types of cardiac lesions predispose to endocarditis?

Answer 8

• rheumatic valve disease or other acquired valve disease
• hypertrophic obstructive cardiomyopathy
• congenital heart disease
• surgically implanted device

Question 9

What are symptoms of acute infective endocarditis?

Answer 9

high grade fever, chills, short of breath, pleurtic chest pain [embolism to lungs]

Question 10

What are first aid mnemomic signs of infective endocarditis?

step1

Answer 10

bacteria FROM JANE

• Fever
• Roth spots [emboli to retina]
• Osler nodes [painful, finger + toe]
• Murmur
• Janeway lesions [painless palm/sole]
• Anemia [of chronic disease]
• Nail bed hemorrhage [splinter hemorrhage]
• emboli

Question 11

What are subacute symptoms of endocarditis?

Answer 11

low grade fever, anorexia, weight loss, fatigue, arthralgias, ab pain, N/V
= signs of chronic disease

Question 12

What are cardiac manifestations of infective endocarditis?

Answer 12

• new regurgitant murmurs
• CHF
• perivalvular abscess
• fistulae
• pericarditis
• MI = due to emboli to coronary arteries

Question 13

Why should you scan the brain before giving someone with infectious endocarditis an anti-coagulant?

Answer 13

because may have emobolus to brain = get mycotic aneurysm

Question 14

What should you think if you see oslers nodes?

Answer 14

strep viridans = likely subacute IE

relatively specific for infectious endocarditis = ainful red nodules on finger tips

Question 15

What should you think if you see janeway lesions?

Answer 15

infectious endocarditis

relatively specific for infectious endocarditis = red, blanching macules, nonpainful
on palms and soles

Question 16

What blood tests should you do if you think infectious endocarditis?

Answer 16

• do CBC for anemia
• do 3 blood cultures at separate sites to confirm bacteria
• do serology for negative culture bugs
• look for competing diagnosis for rheumatoid factor that might resemble infective endocarditis

Question 17

Why do chest xray in infectious endocarditis? Why do EKG?

Answer 17

chest xray: look for focal infiltrates and calcification of heart valves, pneumonia, other foci of infection

EKG: look for evidence of ischemia and arrhythmias

Question 18

Do blood cultures or start antibiotics first?

Answer 18

do blood cultures first so you can establish the cause

Question 19

What are cardiac conditions for which antibiotic prophylaxis is reasonable?

Answer 19

• prosthetic heart valves
• prior history of infectious endocarditis
• unrepaired cyanotic congetical heart disease or repaired incompletely or w/in 6 mo
• valvulopathy after cardiac transplant

Question 20

What are some procedures that warrant endocarditis prophylaxis?

Answer 20

dental procedures
upper resp tract procedures w/ incision of mucosa
GU/GI procedure if infection present

= basically anytime you invade the tissue