Cardiovascular Infections Flashcards Preview

Medicine II: Infectious Disease > Cardiovascular Infections > Flashcards

Flashcards in Cardiovascular Infections Deck (21):
1

Common pathogens of bacterial endocarditis

acute- s. aureus; subacute- strep viridans, strep pneumo; Fungal- candida, aspergillus

2

Pathogens of Native valves

1. Strepto Viridans, 2. S. aureus

3

Pathogens of IV drug users

1. S. aureus, 2. Gram -/Strepto

4

Pathogens of Prosthetic valves

Staphylococcus (early); Streptococcus (late)

5

Difference between subacute and acute bacterial endocarditis

Acute- normal valves, fulminant, high fever, acutely ill, RAPID DESTRUCTION of valve and resulting CHF (high mortality rate).-------Subacute- abnormal valves, indolent- weeks of sx before dx

6

Modified Duke Criteria

2 Major, 5 minor, 1 major and 3 minor needed to dx BE. Major- 2 positive blood test w/ typical pathogen, evidence in cardiac echo (vegitation, abscess, regurg, damage), Q fever-------------Minor- heart disease or IV drug use, fever >33, vascular/immunologic phenomena, positive blood test or echo not in major criteria

7

Presentation of bacterial endocarditis

nonspecific symptoms for ~2 weeks after bacteremia, LOW GRADE FEVER and night sweats, myalgias and arthralgias, low back pain, MURMUR, splenomegaly

8

What are the most common findings in bacterial endocarditis?

Low grade fever and murmur

9

What valves are most affected?

MITRAL, then atrial. Tricuspid is seen in IV drug use

10

What are complications of bacterial endocarditis?

septic emboli, CHF and perivesicular abscess

11

Embolic Phenomena

most common in the conjunctiva. Splinter hemorrhages under nails, Osler nodes (painful red lesions on pads of fingers and toes), Janeway lesions (red macules, nontender), Roth spots (retinal hemorrhages w/clear center)

12

Testing and Dx of Endocarditis

ECHO - transthoracic, look for valvular damage, vegetation (if none do a transesophageal); POSITIVE BLOOD CULTURES IN 95% (do 3 in 24 hours), CXR is final option

13

Transesophageal vs transthoracic echo

TEE is more sensitive than TTE. TEE is always preferred for prosthetic

14

When do we use Endocarditis prophylaxis

recommended in some dental or respiratory procedures. (tonsillectomy, or if surgery breaks respiratory mucosa).

15

What do we use for endocarditis prophylaxis

amoxicillin or ampicillin if NPO

16

Tx for Endocarditis

with a cidal Abx.

17

Tx of Native Valve

vancomycin

18

Tx of prosthetic valve

vancomycin PLUS gentamicin PLUS rifampin; consider consultation

19

If S. Viridans how do we tx?

PCN G/Amp PLUS gentamicin

20

When is surgery appropriate for endocarditis?

have a low threshold for surgery, consult early

21

Indications for surgery in endocarditis

moderate/severe CHF, more than one systemic embolus, uncontrolled infection, resistant bacteria, abscess or leak