B4-013 CBCL: Infectious Cardiac Valve Disease Flashcards
(85 cards)
1
Q
- febrile illness that rapidly damages cardiac structures
- seeds extracardiac sites
- progresses to death within a few weeks if untreated
A
acute endocarditis
2
Q
caused by high virulence organisms involving a normal valve
A
acute endocarditis
3
Q
large vegetations prone to mobilize
A
acute endocarditis
4
Q
- high mortality
- less likely to cure with anti-microbial therapy
- higher incidence of surgical treatment
A
acute endocarditis
5
Q
S. aureus is most common causative organism
A
acute endocarditis
6
Q
indolent, febrile illness developing over weeks or months
A
subacute endocarditis
7
Q
- new or changing cardiac murmur
- embolic phenomena on exam
- usually caused by lower virulence organisms
A
subacute endocarditis
8
Q
common causative agents:
* s. viridans
* enterococci
* HACEK
A
subactute endocarditis
9
Q
smaller vegetations usually formed on abnormal or diseased valves
A
subacute endocarditis
10
Q
less likely to cause structural/tissue damage
higher incidence of cure with antimicrobial therapy
A
subactute endocarditis
11
Q
partially treated acute endocarditis can clinically appear to be
A
subacute endocarditis
12
Q
most common cause of infective endocarditis
A
s. viridans
13
Q
most common cause of infective endocarditis in IV drug users
A
S. aureus
14
Q
most common cause of acute infectious endocarditis
A
S. aureus
15
Q
most common cause of prosthetic valve endocarditis
A
S. epidermis
16
Q
cause of endocarditis due to underlying colon polyps or cancer
A
S. gallolyticus (bovus)
17
Q
HACEK group
A
Hemophilus
Actinobacilus
Cardiobacterium
Ekinella
Kingella
18
Q
commonly associated with negative blood cultures
A
HACEK group
19
Q
causative fungi in immunocompromised patients
A
Candida
20
Q
if portal of entry is:
oral, skin, upper respiratory
what organisms?
A
viridans, staph, HACEK
21
Q
if portal of entry is gastrointestinal
what organism
A
S. gallolyticus (bovus)
22
Q
if portal of entry is GU
what organism
A
enterococci
23
Q
most common cause of community acquired endocarditis
A
S. viridans
24
Q
> 72 hours post admission or with 6-8 weeks after hospital based procedure
A
nosocomial endocarditis
25
three fold increased mortality over community acquired
nosocomial endocarditis
26
common agents of nosocomial endocarditis
* S. aureus
* coag neg Staph
* entercocci
27
6-25% of [....] results in endocarditis
IV catheter related bacteremia
28
causative agents of prosthetic valve endocarditis within 2 months of surgery
| nosocomial
* S. aureus
* coag neg staph
* fungi
29
causative agents: pacemaker/ICD associated endocarditis within weeks of procedure
| nosocomial
* S. aureus
* coag neg staph
30
risk factors for infective endocarditis
* previous endocarditis
* rheumatic heart diease
* degenerative mitral valve
* biscuspid aortic valve
* prosthetic valves
* intravascular device
31
risk factors for bacteremia
* IV drug users
* indwelling venous catheters
* poor dentition
* hemodialysis
* diabetes
32
common clinical manifestations of infective endocarditis
* fever
* elevated ESR
* chills, sweats
* new or changing heart murmur
* anemia
33
retinal hemorrhages with white or pale centers
roth spots
| IE
34
painful, red, raised lesions found on the hands and feet
osler's nodes
| IE
35
brownish, longitudinal lesions in the nailbeds that look like splinters
splinter hemorrhages
| IE
36
non-tender, small erythematous or hemorrhagic macular or nodular lesions on palms and soles
Janeway lesions
| IE
37
* extremely debilitating
* high morbidity/mortality
* presents with constitutional symptoms
* immunocompromised and IV drug users
fungal endocarditis
38
candida species most commonly isolated
fungal endocarditis
39
low rate of positive blood cultures
fungal endocarditis
40
in culture negative endocarditis that fails to respond to anti-bacterial therapy, consider
fungal endocarditis
41
diagnosis of infective endocarditis requires
* modified Duke criteria
* positive blood cultures
* ECG
42
major Duke criteria
* positive blood cultures
* ECG findings
* new valvular regurgitation
43
minor Duke criteria
* predisposing heart lesion of IV drug use
* fever
* vascular lesions
* immunologic phenomena
* ECG findings
44
how many of the Duke criteria need to be met to diagnose IE?
2 major OR
1 major/3 minor OR
5 minor
45
blood cultures should be drawn [...] minutes apart
30
46
how many culture bottles should be drawn?
2-3
from different venipuncture sites
47
common cause of false negative culture results
prior abx use
48
species that are nearly always culture contaminants
* Coag neg staph
* bacillus
* corynebacterium
* propionibacterium
49
allows you to see:
* vegetation size
* intracardiac complications
* assessment of cardiac function
ECG
50
* ECG
* non-invasive
* technically difficult in 20% of patients
* 65% sensitivity, high specificity
TTE
51
* ECG
* 90% sensitivity
* prosthetic valve endocarditis
* myocardial abscess, valve perforation, intracardiac fistula
TEE
52
focal dilation of an artery caused by growth of microorganisms within the vascular wall
mycotic aneurysm
53
complications of IE
* valvular regurgitation
* CHF
* stroke
* peripheral emboli
* mycotic aneurysm
* splenic abscess/infarct
* valve dehiscence
* intracardiac fistula
* complete heart block
54
empiric therapy for acute bacterial endocarditis
vanc + gent
55
empiric therapy for subacute bacterial endocarditis
ceft + gent OR
pencillin + gent OR
ampicillin + gent (enterococci)
56
empiric therapy for prosthetic valve IE
vanc + gent + rifampin OR
vanc + cefepime + gent
57
targeted antibiotic therapy: S. viridans
ceftriaxone 4 week
58
targeted antibiotic therapy: HACEK
ceftriaxone
59
targeted antibiotic therapy: penicillin senstive S. aureus
Nafcillin, Oxacillin, cefazolin
60
targeted antibiotic therapy: MRSA
vanc
61
targeted antibiotic therapy: S. epidermidis
vanc
62
targeted antibiotic therapy: enterococci
ampicillin + gent
63
targeted antibiotic therapy: fungal
ampho + valve replacement
64
surgery required for optimal outcome
* heart failure
* failure of antibiotic therapy
* partially dehisced prosthetic valve
* S. aureus prosthetic valve endocarditis wit intracardiac complication
65
surgery strongly considered
* perivalvular extension of infection
* persistant fever, culture negative
* large vegetations on left valves
* recurrent emboli
* abscess formation
* fungal endocarditis
* large, hypermobile vegetations
66
who may complete outpatient therapy for endocarditis?
fully compliant patients with:
* sterile blood cultures
* no fever
* no ECG findings
* no clinical findings
67
when should prophylaxis be used in patients with cardiac conditions that predispose them to IE?
prior to:
* dental procedures with blood
* respiratory procedures
68
endocarditis ppx is not needed for
* GI, GU, OBGYN procedures
* native valve disease
69
endocarditis ppx regimen for patients **without** penicillin allergy
amoxicillin 2g PO 30-60 min before procedure
70
endocarditis ppx regimen for patients **with** penicillin allergy
clindamycin 600 mg
71
most important factor for endocarditis prevention
maintenance of good oral hygiene
72
* inflammatory and immunologic disease
* usually in children
* follows GAS infection
acute rheumatic fever
73
valve leaflets deformed by chronic inflammation, fibrosis, and vascular proliferation
acute rheumatic fever
74
autoimmune response to strep antigens resulting in cross reaction to myocardial tissue antigens
acute rheumatic fever
75
necessary to dx rheumatic fever
* preceding GAS infection
* two major or 1 major/1 minor or Jones criteria
75
necessary to dx rheumatic fever
* preceding GAS infection
* two major or 1 major/1 minor or Jones criteria
76
major criteria: Jones
* migratory polyarthritis
* pancarditis
* subcutaneous nodules
* erythema marginatum
* chorea
77
minor criteria: Jones
* fever
* arthralgia
* increase in acute phase reactants
78
shortening, thickening and fusion of chordae tendinae
rheumatic heart disease
79
* fibrous adhesions between free edges of cusps
* thickening and fusion of mitral valve leaflets
rheumatic heart diease
80
reduction in valve orifice are and increased diastolic pressure
rhuematic heart diease
81
* dilation of left atrium
* atrial fibrillation
rheumatic heart disease
82
* left atrial appendage thrombus and embolic events
* years/decades later
rheumatic heart disease
83
pulmonary hypertension & right side heart failure
rheumatic heart disease
84
acute pulmonary edema
rheumatic heart disease
