Endocarditis

Question 1

when do you assume it is endocarditis until proven otherwise

Answer 1

fever + new murmur

Question 2

what % of endocarditis occur on normal valves

Answer 2

50%

Question 3

what is the main cause of IE on normal valves

Answer 3

S aureus

Question 4

risk factors of IE on normal valves

Answer 4

dermatitis,IVI, renal failure, DM, organ transplantation, post op wounds

Question 5

what course does endocarditis run on normal and abnormal valves (acute or subacute)

Answer 5

normal- acute presents acute heart failure and emboli. abnormal- subacute

Question 6

risk factors of IE on abnormal valves

Answer 6

mitral or aortic valve disease; tricuspid valves in IV users; coarctation; patent ductus arteriosus ; prosthetic valves; VSD

Question 7

common cause IE (bacteria)

Answer 7

strep viridans (>35%)

Question 8

other bacterial causes IE

Answer 8

enterococci; staph aureus/epidermidis; diptheroids; microaerophilic streps

Question 9

causes IE (fungi)

Answer 9

candida; aspergillus; histoplasma

Question 10

other causes IE

Answer 10

SLE; malignancy

Question 11

signs- septic

Answer 11

fever, rigors, night sweats, malaise, weight loss, anaemia, splenomegaly, clubbing.

Question 12

signs- cardiac lesions

Answer 12

any new murmur, or changing pre existing murmur. valve destruction, obstruction or severe regurg. aortic root abscess- prolongation PR interval- complete AV block

Question 13

what is a common cause of death in IE

Answer 13

LVF

Question 14

signs- immune complex deposition

Answer 14

vasculitis, glomerulonephritis, acute renal failure. Roth spots, splinter haemorrhages, Oslers nodes

Question 15

signs- embolic

Answer 15

emboli may cause abscesses in organs, Janeways lesions.

Question 16

what criteria is used in diagnosis

Answer 16

Dukes

Question 17

what blood tests are needed to diagnose

Answer 17

cultures- 3 at different times, dif sites at peak of fever. bloods- normochromic, normocytic anaemia; neutrophilia; high ESR/CRP. U&E, Mg2+, LFT.

Question 18

what is urinalysis used for in IE

Answer 18

microscopic haematuria

Question 19

what will the CXR, ECG and echo show

Answer 19

CXR- cardiomegaly; ECG- prolonged PR interval; echo- vegetations, mitral lesions, aortic root abscess

Question 20

when would you consider surgery

Answer 20

heart failure, repeated emboli, valvular obstruction, fungal endo, persistent bacteraemia, myocardial abscess, unstable infected prosthetic valve

Question 21

what are Janeways lesions

Answer 21

non tender erythematous, haemorraghic, or pustular spots on palms or soles.

Question 22

what are oslers nodes

Answer 22

tender and painful, raised, red lesions/spots on fingers or toes

Question 23

antibiotic therapy - blind

Answer 23

amoxicillin, gentamicin, vancomycin

Question 24

antibiotic therapy-staphs

Answer 24

flucloxacillin (+rifampicin +gentamicin for prosthetic valve)

Question 25

antibiotic therapy-streps

Answer 25

benzylpenicillin, if not as sensitive give + gentamicin

Question 26

antibiotic therapy- enterococci

Answer 26

amoxicillin + gentamicin

Question 27

antibiotic therapy- HACEK

Answer 27

amoxicillin 4 weeks, + gentamicin 2 wks