Cardiovascular Infections Flashcards

1
Q

Common pathogens of bacterial endocarditis

A

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

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2
Q

Pathogens of Native valves

A
  1. Strepto Viridans, 2. S. aureus
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3
Q

Pathogens of IV drug users

A
  1. S. aureus, 2. Gram -/Strepto
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4
Q

Pathogens of Prosthetic valves

A

Staphylococcus (early); Streptococcus (late)

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5
Q

Difference between subacute and acute bacterial endocarditis

A

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

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6
Q

Modified Duke Criteria

A

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

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7
Q

Presentation of bacterial endocarditis

A

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

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8
Q

What are the most common findings in bacterial endocarditis?

A

Low grade fever and murmur

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9
Q

What valves are most affected?

A

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

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10
Q

What are complications of bacterial endocarditis?

A

septic emboli, CHF and perivesicular abscess

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11
Q

Embolic Phenomena

A

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)

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12
Q

Testing and Dx of Endocarditis

A

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

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13
Q

Transesophageal vs transthoracic echo

A

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

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14
Q

When do we use Endocarditis prophylaxis

A

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

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15
Q

What do we use for endocarditis prophylaxis

A

amoxicillin or ampicillin if NPO

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16
Q

Tx for Endocarditis

A

with a cidal Abx.

17
Q

Tx of Native Valve

A

vancomycin

18
Q

Tx of prosthetic valve

A

vancomycin PLUS gentamicin PLUS rifampin; consider consultation

19
Q

If S. Viridans how do we tx?

A

PCN G/Amp PLUS gentamicin

20
Q

When is surgery appropriate for endocarditis?

A

have a low threshold for surgery, consult early

21
Q

Indications for surgery in endocarditis

A

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