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Flashcards in 3: Endocarditis Deck (28)
1

risk factors for IE

-poor dental hygiene
***IV drug abuse
-hemodialysis
*indwelling catheters + continued access through skin
-DM
**prosthetic valves

2

most common causative organisms of IE

S. aureus (slow clearing)
Coag (-) staph (early prosthetic valve IE)
Strep- mutans, sanguis, bovis

3

HACEK IE causes

Hemophilus
Actinobacillus
Cardiobacterium hominis
Eikenella
Kingella kingae

Other: Enterococci, fungi, coxiella burnetti

4

what is special about coxiella burnetti IE?

difficult to culture, so for this bug, just need one positive blood culture whereas for the rest of the bugs, you need two positive blood cultures

5

what MUST you look for if you have a patient with bovis IE

colonoscopy - colon cancer!!!!!!!

6

IE signs and symptoms

**FEVER AND A MURMUR/FEVER AND A NEW/CHANGED MURMUR

fever
weight loss
fatigue
heart failure
night sweats
heart murmur
splenomegaly
skin petechiae
conjunctival hemorrhages
splinter hemorrhages
septic shock
Osler nodes
Roth spots
Janeway lesions

7

janeway vs. osler: location

j: soles, palms, thenar and hypothenar eminences, plantar surfaces of toe

o: finger and toe tips, thenar and hypothenar eminences

8

janeway vs. osler: size and shape

j: macules or variable size and irregular shape

o: nodules of 1mm to > 1cm

9

janeway vs. osler: tender?

j: no

o: yes

10

janeway vs. osler: course

j: days to weeks

o: hours to days

11

janeway vs. osler: type of endocarditis

j: acute endocarditis

o: subacute endocarditis

12

janeway vs. osler: culture

j: usually positive

o: usually negative

13

janeway vs. osler: history

j: septic microemboli

o: vasculitis

14

what is a worse complication of IE?

perivalvular abscess
-valve dysfunction
-heart block (late stage finding)
-stroke

15

diagnosis of IE

Modified Dukes Criteria:
-2 major
-1 major + 3 minor
-5 minor

16

major dukes criteria for IE

-lab evidence of IE (2 + blood cultures, 1 + coxiella culture)
-endocardial involvement (TTE, TEE)
-new valvular regurgitation

17

minor dukes criteria for IE

-predisposing heart condition (risk factors)
-fever
-vascular phenomenon (emboli (JL), mycotic aneurysm, hemorrhages)
-immunologic phenomenon (GN, osler nodes, Rh factor, Roth spots, Janeway lesions)
-positive blood culture of not a major organism that causes IE

18

IE treatment

empirically start vancomycin + aminoglycoside
then when you know sensitivity, if PCN sensitive - switch to a PCN + aminoglycoside

2-6 weeks IV abx

19

should you use anticoagulation in IE patients?

not indicated - doesn't prevent embolism and may increase risk of bleeding

20

indications for TEE vs. TTE

TEE: with prosthetic valves
TTE: native valves

21

what is the best first test once you suspect endocarditis?

blood cultures

22

what murmur may present in IE

mitral regurgitation (holosystolic)

23

what is vancomycin red man's syndrome?

a problem with too fast of infusion rate due to histamine release by mast cells- treat by decreasing infusion rate

24

how do you determine sensitivity of a test?

sensitivity = true (+)/ (true (+) + false (-))

25

how do you determine specificity of a test?

specificity = PPV = positive predictive value =
number tested (+)/ all (+)

26

what bug is associated with the following presentation:
homeless, alcoholic, flea bitten man with fever and murmur; echo with vegetations

Bartonella

27

indications for IE prophylaxis

(very rare) - if asked a question, just say no!
-prosthetic valves*
-heart transplant recipient
-previous case of endocarditis*
-uncorrected cyanotic heart disease
PLUS:
-dental work with bleeding* (fillings don't count)
-tonsillectomy/adenoidectomy

28

what medication do you add when someone with a prosthetic valve has IE

rifampin