Clinical : Infective Endocarditis Flashcards Preview

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Flashcards in Clinical : Infective Endocarditis Deck (41):
1

Infective Endocarditis

Infection of the endocardium (including the cardiac valves)

2

Classification of Infective Endocarditis: Clinical Course

Acute: Previously healthy valve, fast progression
Subacute: Unhealthy valves, slower less insidious progression

3

Classification of Infective Endocarditis: Host Substrate

Native Valve Endocarditis
Prosthetic Valve endocarditis
Intravenous Drug use induced endocarditis

4

Epidemiology

2/100,000
Predispositions:
Men more susceptible than women
Older patients more likely to get IE
PROSTHETIC VALVES !!! (Very Likely)
Congenital Heart Disease
PREVIOUS IE
IV Drus use

5

Overall, what is the most common bacterial pathogen that causes IE ?

S. aureus

(2nd would be Viridans Streptococcus.)

6

Most common bacterial pathogen in EARLY PVE ? (Before 60 days)

S. epidermidis (CoNS with S. ludegnesis)

7

Most common bacterial pathogen in LATE PVE ? (After 60 days)

Viridans streptoccocus

8

Most common bacterial pathogen in IVDU Endocarditis ?

S. aureus

9

In IVDU Endocarditis, what side of the heart is preferentially affected ? Is it acute or subacute ?

Right sided heart, damage to the Tricuspid Valve

Acute: The valves were healthy previous to inoculation via IV drug use (most common pathogen is S. aureus)

10

Due to the the involvement of the right heart, what are patients with IVDU Endocarditis prone to ?

Pulmonary emboli !

11

What is often absent from IVDU Endocarditis that is seen in other classifications of the disease ?

THe peripheral stigmata such as splinter hemorrhages

12

Non-Thrombotic Endocarditis

Endocardial injury followed by thrombus of fibrin and platelets

This condition can predispose a person to getting IE since bacteria tend to bind to CT molecules of the thrombus.

13

What are the 4 conditions necessary for IE to occur ? (Except in IVDU Endocarditis)

1. Endocardial damage
2.Thrombus formation
3. Bacterial entry into the blood stream
4. Bacterial adherence to the thrombus/injured surface

14

Most sensitive symptom for Dx of IE ?
Most reliable ?

Fever
Murmur

15

List of Symptoms associated with IE

Fever 80-85
Chills 42-75
Sweats 25
Anorexia 25-55
Weight loss 25-35
Malaise 25-40
Dyspnea 20-40
Cough 25
Stroke 10-20
Headache 15-40
Nau/Vomiting 15-20
Myal/Arthralgia 15-30
Chest Pain 8-35
Abd. Pain 5-15
Back Pain 7-10

16

List of Signs associated with IE

Fever 80-90
Murmur 80-85
Change 10-40
Neurologic 30-40
Embolic 20-40
Splenomegaly 15-50
Clubbing 10-20
Osler nodes 7-10
Splinters (hemorrhage) 5-15
Petechiae 10-40
Janeway 6-10
Roth Spots

17

What are the 5 classical peripheral stigmata of IE

Janeway lesions
Petechiae
Splinter hemorrhages
Osler nodes
Roth spots

18

petechiae

Most frequently found on the conjunctivae, palate, buccal mucosa, and upper extremities

19

Splinter hemorrhage

1-2 mm brown streaks under the nails (of greater significance when seen in the proximal nail bed)

20

Janeway Lesions

PAINLESS, flat (macular), blanching discolorations located on the palms and soles

21

Osler Nodes

Small, TENDER NODULES usually found on the finger and toe pads

22

Roth Spote

Retinal hemorrhages with pale centers

23

Myoctotic anuerysms occur due to emboli landing in arteries and causing a weakening/rupture of the arterial wall. Where do these aneurysms usually occur ?

Can occur in almost any artery ( often occurs in aorta and cerebral arteries)

24

Clubbing (of digits)

Present in some patients with longstanding disease

Due to decreased oxygen supply to the distal extremities

25

What might be found on CBC that would help rule in IE ?

Anemia
Leukocytosis w/ neutrophilia

26

What might be found on urinalysis that would help rule in IE ?

Hematuria, RBC casts

27

What might be found with ESR that would help rule in IE ?

elevated

28

What might be found relating to CRP that would help rule in IE ?

Elevated

29

What percentage of patients with IE have an elevated Rheumatoid Factor ?

50%

30

Definite IE as per the Modified Duke Criteria

2 major criteria
or
1 major and 3 minors
or
5 minor

31

Possible IE as per the Modified Duke Criteria

1 Major and one minor
or
3 minor

32

Major Criteria

Positive blood culture

1.Typical microorganism from two separate cultures
Persistently pos. cultures from; cultures drawn more than 12 hours apart, or all of three or majority of four with first and last drawn at least one hour apart

2.Evidence of endocardial involvement
Positive echo showing oscillating vegetation, or abscess, or dehisced prosthetic valve (starting to break free)

33

Minor Criteria

Predisposition (prosthetic valve, heart defect)

Fever >100.4° F (>38.0° C)

Vascular phenomena (emboli, conj. hemorrhage)

Immunological phenomena( GN, +RF, Osler nodes)

Echo (consistent but not meeting major criteria)

Microbiologic evidence (cultures not meeting major criteria)

34

Complications from IE include :

Heart Failure

Conduction disturbance (AV block)

Septic Embolism or Immunologic complexes that deposit in tissues

35

What is the approximate mortality rate for an individual with IE at 6 months if treated properly ?

25%

If not treated, mortality is 100%

36

IV antibiotics are required in all cases of IE. What is the length of time most patients will need to be on Ab's ?

4-6 weeks
some respond better and can get off of them in 2 weeks

37

Why is myocardial or valve ring abscess an indication for surgery ?

These do not respond well to surgery.

38

Besides myocardial or valve rings abscess, what are the other indications for surgery with IE ?

Heart failure due to valvular dysfunction

Persistent bacteremia despite appropriate antimicrobial therapy (Resistance)

Recurrent embolic events despite appropriate antimicrobial therapy

Presence of large vegetations (>10mm)

Prosthetic valve dehiscence

39

Indications for Emergent Surgery:

Acute aortic insufficiency with early closure of the mitral valve

Rupture of sinus of Valsalva into right-heart chamber

Rupture of sinus of Valsalva into pericardium

40

Prophylaxis for IE is recommended for Urogenital or GI procedures in the general population ?

False

41

Indications for IE prophylaxis

Prosthetic valves

Previous IE

Congenital heart disease

Unrepaired cyanotic lesions
Repaired congenital heart disease with residual
defects
Completely repaired defects, for the first six
months

Cardiac transplant patients with valvulopathy