Clinical Endocarditis Flashcards Preview

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Flashcards in Clinical Endocarditis Deck (40):
1

What is infective endocarditis?

disease caused by microbial infection of the endothelial lining of intracardiac structures.

2

What makes up the vegetation of IE?

mass of platelets, fibrin, mircro colonies of microorganisms, and inflammatory cells.

3

Even though IE most commonly involves the heart valves, where else can it infect?

low pressure side of a VSD, on mural endocardium, or on intracardiac devices

4

What is infective endarteritis?

process involving arteriovenous shunts, arterioarterial shunts (PDA), or coarctation of the aorta.

5

How do we classify IE?

1. Site of infection (left or right heart, or nonvalvular)
2. Temporal evolution
3. Cause of infection (bacteria, fungal, HACEK organism, or culture negative).
4. Predisposing risk factors (native valve, prosthetic valve, or IVDU).

6

What is acute temporal evolution IE?

hectic febrile illness that rapidly damages cardiac structures, seeds extra cardiac sites, and progresses to death in days to 6 weeks if untreated.

7

What is subacute/chronic temporal evolution IE?

indolent course, causes structural cardiac damage only slowly if at all, rarely metastasizes, death in 6 weeks to 3 months, and gradually progressive unless complicated by a major embolic event or ruptured mycotic aneurysm.

8

What is the median age age of a pt with IE?

40

9

How does community acquired IE compare to healthcare associated IE of NATIVE valves?

community acquired= strep viridans, or sometimes staph
healthcare associated= staph

10

Is prothetic valve IE arising within 2 months of valve surgery generally nosocomial (hospital acquired)?

YES and surgery is often required.

11

Is the risk higher or lower for IE in pts with intracardiac defibrillators vs pacemakers?

higher in pts with intracardiac defibrillators (mostly staph aureus).

12

What complications are common with pts who get IE with an implantable device?

septic pulmonary emboli (bilateral)

13

Is the DUKE criteria sensitive for IE of pts with implantable devices?

NO

14

How can you easily recognize IE in IVDU?

track marks at injection site

15

Is incidence of mortality higher or lower in IVDU IE?

lower due to right side of heart being effected (staph aureus is culprit).

16

What pathogen is associated with tap water?

pseudomonas

17

**How does acute left sided IE present?

- sepsis, fever, chills (40%), and tachycardia
- they can also present with CHF (dyspnea, frothy sputum, chest pain).
- murmur of aortic or mitral regurgitation (85%).
- mental status change (similar to stroke symptoms).

18

**How does subacute left sided IE present?

- recurrent intermittent fever (but not as high as acute)
- malaise, anorexia, weight loss
murmur of aortic or mitral regurgitation

19

**How does right sided IE present?

- usually acute
- 60% IVDU
- fever, cough, chest pain, hemoptysis, dyspnea
- pulmonary effusions

20

What should we look for when approaching a pt we suspect has IE?

- new murmur or CHF
- splenomegaly
- clubbing (not specific of EI)
- neurologic symptoms due to brain aneurysm.
- mucosal or conjunctival petechia, splinter hemorrhages, or palpable purpuric skin rashes.
- Janeway lesions (palms and soles)
- Osler nodes (fingers and painful)
- Roth spots on the retina.
- glomerulonephritis

21

What murmur is most associated with IVDU?

tricuspid regurgitation (right side; increases with INSPIRATION, holosystolic) and JVD.

22

What will you hear with mitral regurgitation?

holosystolic murmur best heard at the apex, may be associated with an S3 gallop.

23

What will you hear with aortic regurgitation?

blowing diastolic murmur associated with austin-flint rumbling murmur.

24

What are the symptoms of CHF?

dyspnea, orthopnea, PND, edema, JVD, S3 gallop

25

Are Janeway lesions, Osler nodes, and Roth spots more common in acute or subacute IE?

SUBACUTE

26

What is the primary route of entry for strep viridans, staph and HACEK IE organisms?

oral cavity, skin, and upper respiratory tract

27

What is the primary route of entry for strep bovis in IE?

GI tract

28

What is the primary route of entry for enterococci in IE?

GU tract

29

Why would a pt be culture negative?

due to prior antibiotic exposure, nutritionally variant, or HACEK organisms.

30

*** What are the 3 MAJOR DUKE criteria for IE blood cultures?

1. at least 2 separate positive blood cultures for typical IE mircoorganisms.
2. persistently postive BCs (2 sets drawn 12 hours apart or 3 BCs with the first and last separated by more than 1 hr).
3. single positive culture for Coxiella burnetii or anti-phase 1 antibody titer greater than 1:800.

31

*** What are the 4 MAJOR DUKE criteria for echocardial imaging?

1. new valve regurgitation
2. oscillating intracardiac mass on the valve or supporting structure.
3. abscess
4. dehiscence of prosthetic valve.

32

*** What are the MINOR DUKE criteria for IE?

- predisposing cardiac condition or IVDU
- fever (>100.4)
- positive blood cultures, but not meeting major criteria.
- vascular phenomena (emboli, mycotic aneurysms, petechia, Janeway lesions).
- immunologic phenomena (glomerulonephritis, Osler nodes, Roth spots, or rheumatoid factor).

33

*** Using the Duke criteria, what is a DEFINITE diagnosis?

either:
- pathology or bacteriology of vegetations
- 2 major criteria
- 1 major and 3 minor
- 5 minor

34

*** Using the Duke criteria, what is a POSSIBLE diagnosis?

either:
- 1 major and 1 minor
- 3 minor

35

Can you draw blood cultures from a vascular catheter?

NO due to high incidence of false positives.

36

How do we treat?

deliver antibiotics via central venous catheter

37

What are the indications for surgery with IE?

- acute IE with valve stenosis or regurgitation resulting in CHF.
- fungal or other highly resistant organism.
- heart block, annular or aortic abscess or destructive lesions.
- prothetic valve IE with CHF or failed antibiotic therapy.

38

What is the prognosis for native valve IE with step viridans, HACEK, or enterococci?

survival rate= 85-90% :)

39

Are the survival rates good for IVDU right sided IE?

YES

40

What are the guidelines for IE prophylaxis with dental procedures?

- only those with prosthetic heart valves
- previous IE
- congenital heart disease