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CP Test 1 > B4-013 CBCL: Infectious Cardiac Valve Disease > Flashcards

B4-013 CBCL: Infectious Cardiac Valve Disease Flashcards

1
Q
  • febrile illness that rapidly damages cardiac structures
  • seeds extracardiac sites
  • progresses to death within a few weeks if untreated
A

acute endocarditis

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2
Q

caused by high virulence organisms involving a normal valve

A

acute endocarditis

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3
Q

large vegetations prone to mobilize

A

acute endocarditis

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4
Q
  • high mortality
  • less likely to cure with anti-microbial therapy
  • higher incidence of surgical treatment
A

acute endocarditis

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5
Q

S. aureus is most common causative organism

A

acute endocarditis

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6
Q

indolent, febrile illness developing over weeks or months

A

subacute endocarditis

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7
Q
  • new or changing cardiac murmur
  • embolic phenomena on exam
  • usually caused by lower virulence organisms
A

subacute endocarditis

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8
Q

common causative agents:
* s. viridans
* enterococci
* HACEK

A

subactute endocarditis

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9
Q

smaller vegetations usually formed on abnormal or diseased valves

A

subacute endocarditis

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10
Q

less likely to cause structural/tissue damage
higher incidence of cure with antimicrobial therapy

A

subactute endocarditis

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11
Q

partially treated acute endocarditis can clinically appear to be

A

subacute endocarditis

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12
Q

most common cause of infective endocarditis

A

s. viridans

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13
Q

most common cause of infective endocarditis in IV drug users

A

S. aureus

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14
Q

most common cause of acute infectious endocarditis

A

S. aureus

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15
Q

most common cause of prosthetic valve endocarditis

A

S. epidermis

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16
Q

cause of endocarditis due to underlying colon polyps or cancer

A

S. gallolyticus (bovus)

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17
Q

HACEK group

A

Hemophilus
Actinobacilus
Cardiobacterium
Ekinella
Kingella

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18
Q

commonly associated with negative blood cultures

A

HACEK group

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19
Q

causative fungi in immunocompromised patients

A

Candida

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20
Q

if portal of entry is:
oral, skin, upper respiratory

what organisms?

A

viridans, staph, HACEK

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21
Q

if portal of entry is gastrointestinal

what organism

A

S. gallolyticus (bovus)

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22
Q

if portal of entry is GU

what organism

A

enterococci

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23
Q

most common cause of community acquired endocarditis

A

S. viridans

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24
Q

> 72 hours post admission or with 6-8 weeks after hospital based procedure

A

nosocomial endocarditis

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25
Q

three fold increased mortality over community acquired

A

nosocomial endocarditis

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26
Q

common agents of nosocomial endocarditis

A
  • S. aureus
  • coag neg Staph
  • entercocci
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27
Q

6-25% of [….] results in endocarditis

A

IV catheter related bacteremia

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28
Q

causative agents of prosthetic valve endocarditis within 2 months of surgery

nosocomial

A
  • S. aureus
  • coag neg staph
  • fungi
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29
Q

causative agents: pacemaker/ICD associated endocarditis within weeks of procedure

nosocomial

A
  • S. aureus
  • coag neg staph
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30
Q

risk factors for infective endocarditis

A
  • previous endocarditis
  • rheumatic heart diease
  • degenerative mitral valve
  • biscuspid aortic valve
  • prosthetic valves
  • intravascular device
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31
Q

risk factors for bacteremia

A
  • IV drug users
  • indwelling venous catheters
  • poor dentition
  • hemodialysis
  • diabetes
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32
Q

common clinical manifestations of infective endocarditis

A
  • fever
  • elevated ESR
  • chills, sweats
  • new or changing heart murmur
  • anemia
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33
Q

retinal hemorrhages with white or pale centers

A

roth spots

IE

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34
Q

painful, red, raised lesions found on the hands and feet

A

osler’s nodes

IE

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35
Q

brownish, longitudinal lesions in the nailbeds that look like splinters

A

splinter hemorrhages

IE

36
Q

non-tender, small erythematous or hemorrhagic macular or nodular lesions on palms and soles

A

Janeway lesions

IE

37
Q
  • extremely debilitating
  • high morbidity/mortality
  • presents with constitutional symptoms
  • immunocompromised and IV drug users
A

fungal endocarditis

38
Q

candida species most commonly isolated

A

fungal endocarditis

39
Q

low rate of positive blood cultures

A

fungal endocarditis

40
Q

in culture negative endocarditis that fails to respond to anti-bacterial therapy, consider

A

fungal endocarditis

41
Q

diagnosis of infective endocarditis requires

A
  • modified Duke criteria
  • positive blood cultures
  • ECG
42
Q

major Duke criteria

A
  • positive blood cultures
  • ECG findings
  • new valvular regurgitation
43
Q

minor Duke criteria

A
  • predisposing heart lesion of IV drug use
  • fever
  • vascular lesions
  • immunologic phenomena
  • ECG findings
44
Q

how many of the Duke criteria need to be met to diagnose IE?

A

2 major OR
1 major/3 minor OR
5 minor

45
Q

blood cultures should be drawn […] minutes apart

A

30

46
Q

how many culture bottles should be drawn?

A

2-3
from different venipuncture sites

47
Q

common cause of false negative culture results

A

prior abx use

48
Q

species that are nearly always culture contaminants

A
  • Coag neg staph
  • bacillus
  • corynebacterium
  • propionibacterium
49
Q

allows you to see:
* vegetation size
* intracardiac complications
* assessment of cardiac function

A

ECG

50
Q
  • ECG
  • non-invasive
  • technically difficult in 20% of patients
  • 65% sensitivity, high specificity
A

TTE

51
Q
  • ECG
  • 90% sensitivity
  • prosthetic valve endocarditis
  • myocardial abscess, valve perforation, intracardiac fistula
A

TEE

52
Q

focal dilation of an artery caused by growth of microorganisms within the vascular wall

A

mycotic aneurysm

53
Q

complications of IE

A
  • valvular regurgitation
  • CHF
  • stroke
  • peripheral emboli
  • mycotic aneurysm
  • splenic abscess/infarct
  • valve dehiscence
  • intracardiac fistula
  • complete heart block
54
Q

empiric therapy for acute bacterial endocarditis

A

vanc + gent

55
Q

empiric therapy for subacute bacterial endocarditis

A

ceft + gent OR
pencillin + gent OR
ampicillin + gent (enterococci)

56
Q

empiric therapy for prosthetic valve IE

A

vanc + gent + rifampin OR
vanc + cefepime + gent

57
Q

targeted antibiotic therapy: S. viridans

A

ceftriaxone 4 week

58
Q

targeted antibiotic therapy: HACEK

A

ceftriaxone

59
Q

targeted antibiotic therapy: penicillin senstive S. aureus

A

Nafcillin, Oxacillin, cefazolin

60
Q

targeted antibiotic therapy: MRSA

A

vanc

61
Q

targeted antibiotic therapy: S. epidermidis

A

vanc

62
Q

targeted antibiotic therapy: enterococci

A

ampicillin + gent

63
Q

targeted antibiotic therapy: fungal

A

ampho + valve replacement

64
Q

surgery required for optimal outcome

A
  • heart failure
  • failure of antibiotic therapy
  • partially dehisced prosthetic valve
  • S. aureus prosthetic valve endocarditis wit intracardiac complication
65
Q

surgery strongly considered

A
  • perivalvular extension of infection
  • persistant fever, culture negative
  • large vegetations on left valves
  • recurrent emboli
  • abscess formation
  • fungal endocarditis
  • large, hypermobile vegetations
66
Q

who may complete outpatient therapy for endocarditis?

A

fully compliant patients with:
* sterile blood cultures
* no fever
* no ECG findings
* no clinical findings

67
Q

when should prophylaxis be used in patients with cardiac conditions that predispose them to IE?

A

prior to:
* dental procedures with blood
* respiratory procedures

68
Q

endocarditis ppx is not needed for

A
  • GI, GU, OBGYN procedures
  • native valve disease
69
Q

endocarditis ppx regimen for patients without penicillin allergy

A

amoxicillin 2g PO 30-60 min before procedure

70
Q

endocarditis ppx regimen for patients with penicillin allergy

A

clindamycin 600 mg

71
Q

most important factor for endocarditis prevention

A

maintenance of good oral hygiene

72
Q
  • inflammatory and immunologic disease
  • usually in children
  • follows GAS infection
A

acute rheumatic fever

73
Q

valve leaflets deformed by chronic inflammation, fibrosis, and vascular proliferation

A

acute rheumatic fever

74
Q

autoimmune response to strep antigens resulting in cross reaction to myocardial tissue antigens

A

acute rheumatic fever

75
Q

necessary to dx rheumatic fever

A
  • preceding GAS infection
  • two major or 1 major/1 minor or Jones criteria
75
Q

necessary to dx rheumatic fever

A
  • preceding GAS infection
  • two major or 1 major/1 minor or Jones criteria
76
Q

major criteria: Jones

A
  • migratory polyarthritis
  • pancarditis
  • subcutaneous nodules
  • erythema marginatum
  • chorea
77
Q

minor criteria: Jones

A
  • fever
  • arthralgia
  • increase in acute phase reactants
78
Q

shortening, thickening and fusion of chordae tendinae

A

rheumatic heart disease

79
Q
  • fibrous adhesions between free edges of cusps
  • thickening and fusion of mitral valve leaflets
A

rheumatic heart diease

80
Q

reduction in valve orifice are and increased diastolic pressure

A

rhuematic heart diease

81
Q
  • dilation of left atrium
  • atrial fibrillation
A

rheumatic heart disease

82
Q
  • left atrial appendage thrombus and embolic events
  • years/decades later
A

rheumatic heart disease

83
Q

pulmonary hypertension & right side heart failure

A

rheumatic heart disease

84
Q

acute pulmonary edema

A

rheumatic heart disease

CP Test 1 (16 decks)

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