Flashcards in 3: Endocarditis Deck (28)
risk factors for IE
-poor dental hygiene
***IV drug abuse
*indwelling catheters + continued access through skin
most common causative organisms of IE
S. aureus (slow clearing)
Coag (-) staph (early prosthetic valve IE)
Strep- mutans, sanguis, bovis
HACEK IE causes
Other: Enterococci, fungi, coxiella burnetti
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
what MUST you look for if you have a patient with bovis IE
colonoscopy - colon cancer!!!!!!!
IE signs and symptoms
**FEVER AND A MURMUR/FEVER AND A NEW/CHANGED MURMUR
janeway vs. osler: location
j: soles, palms, thenar and hypothenar eminences, plantar surfaces of toe
o: finger and toe tips, thenar and hypothenar eminences
janeway vs. osler: size and shape
j: macules or variable size and irregular shape
o: nodules of 1mm to > 1cm
janeway vs. osler: tender?
janeway vs. osler: course
j: days to weeks
o: hours to days
janeway vs. osler: type of endocarditis
j: acute endocarditis
o: subacute endocarditis
janeway vs. osler: culture
j: usually positive
o: usually negative
janeway vs. osler: history
j: septic microemboli
what is a worse complication of IE?
-heart block (late stage finding)
diagnosis of IE
Modified Dukes Criteria:
-1 major + 3 minor
major dukes criteria for IE
-lab evidence of IE (2 + blood cultures, 1 + coxiella culture)
-endocardial involvement (TTE, TEE)
-new valvular regurgitation
minor dukes criteria for IE
-predisposing heart condition (risk factors)
-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
empirically start vancomycin + aminoglycoside
then when you know sensitivity, if PCN sensitive - switch to a PCN + aminoglycoside
2-6 weeks IV abx
should you use anticoagulation in IE patients?
not indicated - doesn't prevent embolism and may increase risk of bleeding
indications for TEE vs. TTE
TEE: with prosthetic valves
TTE: native valves
what is the best first test once you suspect endocarditis?
what murmur may present in IE
mitral regurgitation (holosystolic)
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
how do you determine sensitivity of a test?
sensitivity = true (+)/ (true (+) + false (-))
how do you determine specificity of a test?
specificity = PPV = positive predictive value =
number tested (+)/ all (+)
what bug is associated with the following presentation:
homeless, alcoholic, flea bitten man with fever and murmur; echo with vegetations
indications for IE prophylaxis
(very rare) - if asked a question, just say no!
-heart transplant recipient
-previous case of endocarditis*
-uncorrected cyanotic heart disease
-dental work with bleeding* (fillings don't count)