Infective Endocarditis Lecture Powerpoint

Question 1

Infective endocarditis

Answer 1

Infection of the hearts endocardial surface, most commonly involving the valves but may also occur at a septal defect or chordae tendinae, can be acute or subacute

Question 2

Risk factors associated with infective endocarditis (5)

Answer 2

• underlying cardiac structural abnormalities
• pacemaker infections
• prolonged surgery
• catheter related bacteremia
• IV drug abuse or piercings

Question 3

Infective endocarditis factors affecting mortality (4)

Answer 3

• Virulence and health of patient
• Embolism of bacteria
• Immunocompromised patient
• If left untreated, uniformly fatal

Question 4

3 big presenting signs and symptoms of endocarditis

Answer 4

• fever
• onset of new murmur
• positive blood cultures

Question 5

Microorganisms associated with native valve endocarditis (3)

Answer 5

• S aureus (skin, iv drug use)
• viridans group streptococci (most common)
• HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella: uncommon, seen in immunocompromised hosts)

Question 6

Microorganisms associated with prosthetic valve endocarditis (3)

Answer 6

• coag neg staphylococci
• fungi
• staphylococci (from defibrillator/pacemaker)

Question 7

Signs of embolization of vegetation from infective endocarditis in periphery (4)

Answer 7

• pectechiae (small hemorrhages sometimes in nailbeds [called splinter hemorrhages])
• osler’s node (painful, purple lesions on fingers and toes)
• janeway lesions (flat, painless red lesions on palms and soles)
• roth spots (retinal hemorrhages with pale or yellow centers)

Question 8

Modified Duke Criteria

Answer 8

Clinical criteria for diagnosing infective endocarditis requiring a combo of major and minor criteria

Question 9

Lab findings indicative of infective endocarditis (5)

Answer 9

• anemia (normocytic, normochromatic)
• hypergammaglobulinemia
• leukocytosis
• RBC casts
• Pos blood culture**

Question 10

Blood culturing process for infective endocarditis

Answer 10

• 3 sets drawn at least 1 hour apart for 3 diff mediums (aerobic, anaerobic, fungal)
• as soon as positive is obtained then starting broad spectrum antibiotic treatment
• narrow down once culture and sensitivity obtained

Question 11

IV drug users will see growth of vegetation mostly on ____ sided valves

Answer 11

Right

Question 12

Transthoracic echocardiogram should always precede a ____ one

Answer 12

transesophageal

Question 13

Valvular dehiscence

Answer 13

Refers to the separating of an artificial valve from its anchor due to vegetation overgrowth resulting in rocking motion of prosthetic valve back and forth with blood flow

Question 14

Infective endocarditis treatment (2)

Answer 14

Hospitalization and IV antibiotics:

• PCN and gentamycin IV daily for 4 weeks (most common)
• vanco or ceftriaxone IV daily 4 weeks

Question 15

Indications for surgery to treat native valve endocarditis (4)

Answer 15

• acute mitral or aortic regurg with heart failure
• fungal endocarditis
• evidence of aortic abscess
• valve dysfunction and persistent infection after 7-10 days of antibiotic treatment

Question 16

Indications for surgery to treat prosthetic valve endocarditis (4)

Answer 16

• early prosthetic valve endocarditis (first 2 months after surgery)
• fungal endocarditis
• evidence of paravalvular leak or aortic abscess
• vegetation of any size on or near the prosthesis

Question 17

Optimal duration of antibiotic therapy after surgery for treatment of infective endocarditis

Answer 17

unknown exactly, but at least weeks to months

Question 18

5 year mortality of infective endocarditis

Answer 18

54-87%

Question 19

Procedures that put patients at elevated risk of infective endocarditis and which is most common? (5)

Answer 19

• endoscopy
• colonoscopy
• dental extractions
• TURP (most common)
• transesophageal echocardiography

Question 20

Antibiotic prophylaxis for infective endocarditis (2)

Answer 20

• amoxicillin 2 g 1 hr prior to procedure***

- clindamycin 600mg if allergic

Question 21

Who get infective endocarditis prophylaxis? (4)

Answer 21

• all patients with prosthetic heart valves or other mechanical part of heart
• all patients with pmh of endocarditis
• patients with complex congenital heart disease including palliative shunts
• all patients with left sided valvular heart disease

Question 22

Infective endocarditis complications (3)

Answer 22

• Stroke
• Embolization
• vegetative damage to leaflets of valve