Cardiovascular: Infective endocarditis (brief)

Question 1

what is endocarditis?

Answer 1

infection of the endocardium

Question 2

what are the orders of heart muscle from inside the heart to out?

Answer 2

endocardium 
myocardium 
visceral pericardium
pericardial cavity 
parietal pericardium 
fibrous layer

Question 3

how does endocarditis occur?

Answer 3

bacteria enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue

Question 4

what are the most common bacteria to cause endocarditis?

Answer 4

staph aureus (most commonly)

others include: Viridans streptococci, Staphylococcus epidermidis (prosthetics), Enterococcus faecalis, Streptococcus bovis, Coxiella burnetti (animals).

Question 5

what are risk factors for endocarditis?

Answer 5

• artificial heart valves
• congenital heart defects
• personal history of endocarditis
• damaged heart valves
• IV. drug use
• hypertrophic cardiomyopathy

Question 6

what are some clinical features of endocarditis?

Answer 6

• flu-like symptoms
• new or changed murmur
• fatigue
• aching joints/muscles
• night sweats
• SOB
• chest pain when you breathe

Question 7

which conditions present in a similar way to endocarditis?

Answer 7

SLE. 
Cardiac tumours.
Lyme disease. 
Antiphospholipid syndrome. 
Polymyalgia rheumatica. 
Reactive arthritis.

Question 8

what investigations would you conduct to confirm a diagnosis of endocarditis?

Answer 8

• blood cultures
• FBC
• echo/transoesophageal echo
• ECG
• CXR

Question 9

what is the treatment for infective endocarditis?

Answer 9

IV antibiotics - Once cultures have been collected, broad-spectrum antibiotic therapy should be initiated until sensitivities are known.

Surgery sometimes recommended to remove. infective tissue

Question 10

which antibiotic may be prescribed to prevent endocarditis as a preoperative prophylaxis?

Answer 10

vancomycin

[in patients at high risk of developing bacterial endocarditis when undergoing major surgical procedures]

Question 11

what signs may you find on examination with a patient with endocarditis?

Answer 11

Murmur / septic emboli / splinter haemorrhages / Janeway lesions / Osler’s nodes / Roth spots / clubbing / arthritis / fever / anaemia / splenomegaly

Question 12

what is the prognosis of endocarditis?

Answer 12

good - 90% of patients recover with treatment.