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Pathophysiology - Cardiovascular > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

What will characterize the acute course of presentation of infective endocarditis?

A

Rapid onset, with large vegetations involving previously NORMAL valves

  • > high fever, acute pulmonary edema due to regurgitation
  • > high rate of embolic complications infarcting tissues
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2
Q

What will characterize the subacute course of presentation of infective endocarditis?

A

Long illness, lasting weeks to months, with small vegetations involving previously DISEASED or ABNORMAL valves

  • > low grade fever, may be intermittent
  • > constitutional symptoms will be associated: fatigue, anorexia, wasting, night sweats, myalgias
  • > Immune complex deposition likely - causing arthritis / hematuria
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3
Q

What are the common classifications of IE by host substrate?

A

Native valve endocarditis (NVE)
Prosthetic valve endocarditis (PVE)
Endocarditis in the setting of IV drug use

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4
Q

What are some miscellaneous classifications of IE by substrate?

A
  1. Endarteritis of coarctation - in the aorta

2. Endocarditis of prosthetic material -> i.e. kids operated on for congenital heart disease

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5
Q

Most common causes of native valve endocarditis?

A

Staphylococcus aureus and Streptococcus spp.

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6
Q

Most common cause of prosthetic valve endocarditis?

A

Staphylococcus epidermidis

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7
Q

Why does having foreign material in the circulation (i.e. pacemakers, IV lines) predispose you to endocarditis?

A

It has no endothelium -> cannot stop the clotting cascade. Perfect nidus for thrombus -> endocarditis transition

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8
Q

What does it mean when you begin to see first or second degree AV block in a patient with IE?

A

Poor prognosis -> probable formation of abscess in the conducting system of the heart

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9
Q

Why types of endocarditis can lead to septic pulmonary embolism?

A

Triscuspid or pulmonary valve endocarditis

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10
Q

What are some common metastatic infections which can occur as a result of septic emboli in the left heart?

A

Septic joints, and vertebral osteomyelitis (will manifest as back pain)

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11
Q

What are the “vascular phenomena” resulting from septic

emboli?

A
  1. Infarct of a tissue - i.e. renal artery or splenic artery
  2. Mycotic aneurysms - due to embolization to vasa vasorum of arteries -> localized aneurysm formation in many vessels, especially cerebral
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12
Q

What are the complications of IE caused by immune complex deposition?

A
  1. Glomerulonephritis -> acute renal failure
  2. Polyserositis -> arthritis
  3. Vasculitis -> rashes
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13
Q

What age group gets most IE and why?

A

> 60 years old, because greater than 50% of cases are due to predilection from calcific aortic stenosis

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14
Q

What are the clinical symptoms exhibited by most patients in endocarditis?

A

Fever, new or changing heart murmur

Constitutional symptoms if subacute

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15
Q

How an IE cause neurologic symptoms, flank pain, chest pain, gangrene, and blindness?

A

All of these are embolic complications

Neurologic: embolic stroke
Flank pain: Renal artery
Chest pain: pulmonary embolism
Gangrene: deposition in extremities
Blindness: Central retinal artery
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16
Q

What are Janeway lesions and what organism is usually associated with them?

A

Small, PAINLESS, hemorrhagic macular lesions of PALMS and SOLES

->S. aureus is associated

17
Q

What are Roth spots? how do they look?

A

Emboli to retina causing hemorrhage with a clear center which is coagulated fibrin

-> can be seen in other diseases as well (diabetes, leukemia, pernicious anemia)

18
Q

Where else on the face can hemorrhages occur on IE?

A

Most frequently conjunctival and subconjunctival hemorrhaging

19
Q

What are splinter hemorrhages? Why do they happen?

A

Linear, red / brown lines seen in MID (not traumatic) nail beds of fingers / toes

Happen due to vasculitis or hemorrhage in distal capillaries from microemboli

20
Q

What can be seen in IE due to immune complex deposition in small vessels, and will cover entire feet sometimes?

A

Petechiae -> small hemorrhages of skin or mucous membranes

21
Q

What are Osler’s nodes? How do you remember their different from Janeway lesions?

A

PAINFUL, RAISED lumps sometimes with clear centers, usually on pads of fingers and toes, due to immune complex deposition with acute inflammation

  • > acute inflammation / edema is what makes them raised up and painful
  • > Janeway lesions are just infarct / bleeding not associated with inflammation
22
Q

Is IE associated with anemia? What does this do to ESR?

A

Yes -> especially in chronic, subacute infection

Tends to elevate ESR -> fewer RBCs to block droppage -> rate of droppage / sedimentation is faster

23
Q

What is the most sensitive test for IE and why is this not typically done?

A 
Transesophageal echocardiography (TEE)
-> 90% detection of vegetations >1mm in size

Not typically done because it’s expensive and invasive -> transthoracic echo is much cheaper and 65% sensitive for >3 mm in size

24
Q

What are the major duke criteria for infective endocarditis?

A

Major:

  1. Typical organisms identified from two separate blood cultures @ different locations
  2. Single positive blood culture with Coxiella burnetti
  3. New valvular regurgitation or positive TEE
25
Q

What are the minor duke criteria for IE?

A
  1. Predisposition factors for IE
  2. Fever
  3. Vascular phenomena - i.e. infarcts, mycotic aneurysms
  4. Immunologic phenomena - i.e. arthritis, GN
  5. One positive blood culture
26
Q

How many major / minor criteria do you need for a DEFINITIVE IE diagnosis?

A 
Two major
or
One major and three minor
or
Five minor
27
Q

When is surgery for IE indicated?

A

Persistent infection or recurrent emboli despite 7-10 days of adequate antibiotics (often two)
Annular or aortic abscess
Congestive heart failure

28
Q

What procedures warrant prophylaxis with antibiotics for the transient bacteremia they will incur?

A
  1. Dental procedures

2. Cystoscopy if infection is present -> high risk of enterococcal endocarditis

29
Q

What patients are at high risk with transient bacteremia and should thus receive prophylaxis during these procedures?

A
  1. Prior history of endocarditis
  2. Prosthetic valves
  3. Cardiac transplant recipients
  4. Congenital heart diseases -> unrepaired cyanotic, prosthetic material within 6 months of repair surgery, or residual defect adjacent to prosthetic material from repair surgery

Pathophysiology - Cardiovascular (24 decks)

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