Endocarditis, Myocarditis, Pericarditis

Question 1

what does the presence of bacteria in the bloodstream indicate?

Answer 1

there is a focus of infection elsewhere in the body

Question 2

what staphylococcus species is the most likely to infect prosthetic material?

Answer 2

staphylococcus epidermidis

Question 3

what is infective endocarditis?

Answer 3

infection of the endothelium of the heart valves

Question 4

what are the 4 main classes of predisposing factors for infective endocarditis?

Answer 4

heart valve abnormality
prosthetic heart valve
IVDU
intravascular lines

Question 5

what type of heart valve abnormalities predispose to infective endocarditis?

Answer 5

calcification/sclerosis of heart valves (in elderly)
congenital heart disease
post rheumatic fever

Question 6

what is the pathogenesis of infective endocarditis?

Answer 6

1. heart valve damaged
2. turbulent blood flow over roughened endothelium
3. platelets/fibrin depositis forming a thrombi
4. bacteraemia (possibly transient)
5. organisms settle in fibrin/platelet thrombi becoming a microbial vegetation

Question 7

what is the most common side of the heart to be affected?

Answer 7

left side

mitral and aortic valves

Question 8

what are the 4 main organisms causing endocarditis of native valves?

Answer 8

staphylococcus aureus
viridans streptococci
enterococcus sp
staphylococcus epidermidis

Question 9

what are the 3 classes of unusual organisms that can cause endocarditis?

Answer 9

atypicals (eg chlamydia psittaci, coxiella burnetii)
gram-negatives
fungi

Question 10

what is the presentation of acute endocarditis?

Answer 10

overwhelming sepsis and cardiac failure

Question 11

what is the presentation of subacute endocarditis?

Answer 11

fever
malasie
weight loss
tiredness
breathlessness

Question 12

what are the sings on examination of infective endocarditis?

Answer 12

Fever
Roth spots
Osler nodes
Murmur (new or changing)
Janeway lesions
Anaemia
Nail (splinter) haemorrhages
Emboli
\+ finger clubbing, splenomegaly

Question 13

what can present in the urine of a patient with infective endocarditis?

Answer 13

(microscopic) haematuria

Question 14

how do you diagnose infective endocarditis?

Answer 14

take 3 sets of blood cultures before antibiotics

echocardiogram

Question 15

why must you take 3 sets of blood cultures for diagnosing infective endocarditis?

Answer 15

to ensure you haven’t just identified a contaminent

Question 16

if you suspect infective endocarditis but all 3 blood cultures are negative what should you do?

Answer 16

consider serology for ‘atypical’ organisms

Question 17

what are the 2 types of prosthetic valve endocarditis?

Answer 17

early

late

Question 18

what is early prosthetic valve endocarditis?

Answer 18

infected at time of valve insertion

Question 19

what is late prosthetic valve endocarditis?

Answer 19

up to many years after valve insertion

Question 20

what are the main causative organisms of early prosthetic valve endocarditis?

Answer 20

staph epidermidis

staph aureus

Question 21

what are the causative organisms of late porsthetic valve endocarditis?

Answer 21

co-incidental bacteraemia

Question 22

what sided infective endocarditis to IVDUs usually get?

Answer 22

right sided

mainly tricuspid valve

Question 23

what is the usual causative organisms in a IVDU who has infective endocarditis?

Answer 23

staph aureus

Question 24

what does infective endocarditis in an IVDU often present as?

Answer 24

as staph aureus pneumonia

Question 25

what is the empirical treatment for native valve endocarditis infective endocarditis? (ie before microbiology results come back)

Answer 25

benzylpenicillin and gentamicin

IV

Question 26

what is the empirical treatment for prosthetic valve endocarditis? (ie before microbiology results come back)

Answer 26

vanomycin and gentamicin

IV

Question 27

what is the empirical treatment for drug use endocarditis? (ie before microbiology results come back)

Answer 27

flucloxacillin

IV

Question 28

what is the antibiotic treatment for infective endocarditis where microbiology results show staph aureus (not MRSA) is the causative organism?

Answer 28

flucloxacillin IV

Question 29

what is the antibiotic treatment for infective endocarditis where microbiology results show MRSA is the causative organism?

Answer 29

vancomycin and gentamicin

IV

Question 30

what is the antibiotic treatment for infective endocarditis where microbiology results show viridans streptococci is the causative organism?

Answer 30

benzylpenicillin and gentamicin

IV

Question 31

what is the antibiotic treatment for infective endocarditis where microbiology results show enterococcus sp is the causative organism?

Answer 31

amoxicillin/vancomycin and gentamicin

IV

Question 32

what is the antibiotic treatment for infective endocarditis where microbiology results show staph epidermidis is the causative organism?

Answer 32

vancomycin and gentamicin

IV

Question 33

in regards to treatment for infective endocarditis, how long should antibiotics be given for?

Answer 33

4-6 weeks

Question 34

if antibiotic therapy for infective endocarditis is failing what should you consider?

Answer 34

surgery

Question 35

what is myocarditis?

Answer 35

inflammation of cardiac muscle

Question 36

what are the symptoms of myocarditis?

Answer 36

fever
chest pain
SOB
palptations

Question 37

what are the signs of myocarditis?

Answer 37

pyrexial
arrythmia
cardiac failure

Question 38

what are the main causes of myocardiis?

Answer 38

enteroviruses- coxsackie A + B, echovirus

other eg influenza

Question 39

how is myocarditis diagnosed?

Answer 39

viral culture/PCR
throat swab + stool for enteroviruses
throat swab and serology for influenza

Question 40

what is the treatment of myocarditis?

Answer 40

supportive

Question 41

what is pericarditis?

Answer 41

inflammation of the pericardium

Question 42

what is the main feature of pericarditis?

Answer 42

chest pain

Question 43

what is the treatment of pericarditis?

Answer 43

• supportive if viral cause

- antibiotics and drainage if bacterial cause

Question 44

what are the 2 main sequellae of infective endocarditis?

Answer 44

valvular heart disease

emboli