Flashcards in Clinical : Infective Endocarditis Deck (41):
Infection of the endocardium (including the cardiac valves)
Classification of Infective Endocarditis: Clinical Course
Acute: Previously healthy valve, fast progression
Subacute: Unhealthy valves, slower less insidious progression
Classification of Infective Endocarditis: Host Substrate
Native Valve Endocarditis
Prosthetic Valve endocarditis
Intravenous Drug use induced endocarditis
Men more susceptible than women
Older patients more likely to get IE
PROSTHETIC VALVES !!! (Very Likely)
Congenital Heart Disease
IV Drus use
Overall, what is the most common bacterial pathogen that causes IE ?
(2nd would be Viridans Streptococcus.)
Most common bacterial pathogen in EARLY PVE ? (Before 60 days)
S. epidermidis (CoNS with S. ludegnesis)
Most common bacterial pathogen in LATE PVE ? (After 60 days)
Most common bacterial pathogen in IVDU Endocarditis ?
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)
Due to the the involvement of the right heart, what are patients with IVDU Endocarditis prone to ?
Pulmonary emboli !
What is often absent from IVDU Endocarditis that is seen in other classifications of the disease ?
THe peripheral stigmata such as splinter hemorrhages
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.
What are the 4 conditions necessary for IE to occur ? (Except in IVDU Endocarditis)
1. Endocardial damage
3. Bacterial entry into the blood stream
4. Bacterial adherence to the thrombus/injured surface
Most sensitive symptom for Dx of IE ?
Most reliable ?
List of Symptoms associated with IE
Weight loss 25-35
Chest Pain 8-35
Abd. Pain 5-15
Back Pain 7-10
List of Signs associated with IE
Osler nodes 7-10
Splinters (hemorrhage) 5-15
What are the 5 classical peripheral stigmata of IE
Most frequently found on the conjunctivae, palate, buccal mucosa, and upper extremities
1-2 mm brown streaks under the nails (of greater significance when seen in the proximal nail bed)
PAINLESS, flat (macular), blanching discolorations located on the palms and soles
Small, TENDER NODULES usually found on the finger and toe pads
Retinal hemorrhages with pale centers
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)
Clubbing (of digits)
Present in some patients with longstanding disease
Due to decreased oxygen supply to the distal extremities
What might be found on CBC that would help rule in IE ?
Leukocytosis w/ neutrophilia
What might be found on urinalysis that would help rule in IE ?
Hematuria, RBC casts
What might be found with ESR that would help rule in IE ?
What might be found relating to CRP that would help rule in IE ?
What percentage of patients with IE have an elevated Rheumatoid Factor ?
Definite IE as per the Modified Duke Criteria
2 major criteria
1 major and 3 minors
Possible IE as per the Modified Duke Criteria
1 Major and one minor
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)
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)
Complications from IE include :
Conduction disturbance (AV block)
Septic Embolism or Immunologic complexes that deposit in tissues
What is the approximate mortality rate for an individual with IE at 6 months if treated properly ?
If not treated, mortality is 100%
IV antibiotics are required in all cases of IE. What is the length of time most patients will need to be on Ab's ?
some respond better and can get off of them in 2 weeks
Why is myocardial or valve ring abscess an indication for surgery ?
These do not respond well to surgery.
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
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
Prophylaxis for IE is recommended for Urogenital or GI procedures in the general population ?