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Flashcards in Endocarditis Deck (23):
0

Suspect patient with tricuspid endocarditis – next steps?

Obtain serial blood cultures and institute empiric broad-spectrum antibiotics

1

Endocarditis from staph aureus versus strep viridans?

Acute versus subacute endocarditis

2

Acute verses subacute endocarditis?

Acute – high fever, Valvular regurgitation, emboli

Subacute –
1. Constitutional symptoms (anorexia, weight loss, night sweats)
2. Complex deposition
3. septic vasculitis (petechia, splenomegaly, glomerulonephritis)

3

Stereotypical symptoms of endocarditis?

FROM JANE
Fevers
Roth spots
Osler's nodes
Murmur
Janeway lesions
Anemia
Nailbed hemorrhages
Emboli

4

Unique complication of right-sided endocarditis?

Pulmonary emboli
Pleuritic chest pain
Purulent sputum
Hemoptysis

CXR: peripheral nodular lesions with cavitation

5

Criteria for obtaining blood cultures?

Acute – three blood cultures over 2 to 3 hour period prior to initiating antibiotics

Subacute – three blood cultures over 24 hour period

6

Endocarditis from intravascular catheter?

Staph aureus/Candida

7

Endocarditis in pt with prosthetic valves?

Coagulase negative staph (epidermidis)

8

Endocarditis after UTI? Treatment?

Enterococci

Ampicillin an gentamicin

9

Endocarditis in neonates?

Coagulase negative staph

10

Endocarditis in patient with G.I. problem?

Strep bovis

11

Duke Major criteria?

1. Two positive blood cultures
2. Evidence of endocardial involvement (echo evidence, new valvular regurgitation, oscillating intracardiac mass)

12

Duke minor criteria?

1. Predisposing Valvular lesion
2. IV drug use
3. Fever over 38
4. Vascular signs (septic pulmonary emboli, mycotic aneurysm, Janeway lesions)
5. Immunologic phenomenon (glomerulonephritis, Osler's nodes, Roth spots, RF)

FIVIV

13

How to evaluate endocarditis based on Duke criteria?

1. Two major criteria
2. One major and three minor criteria
3. Five minor criteria

14

Life-threatening complication endocarditis?

Congestive heart failure as a consequence of vascular damage

15

Other cardiac complications of endocarditis?

1. Abscesses
2. Conduction disturbances
3. Arterial emboli causing splenic and renal infarctions
4. Emboli causing MI or stroke
5. Mycotic aneurysms (rupture can lead to hemorrhage)

16

Treatment for streptococcus endocarditis?

For staph aureus endocarditis?

For HACEK?

For fungal?

Ceftriaxone

Nafcillin/Vanc with gentamicin ( vancomycin if MRSA or CoNS)

Ceftriaxone

Amphotericin and valve replacement

17

Need surgical management of endocarditis if?

1. Positive cultures after seven days of therapy
2. Fungal endocarditis
3. Prosthetic valves
4. Myocardial abscess formation
5. One serious embolic episode or >10 mm vegetation
6. AV block
7. CHF/ruptured cordae tendonae

18

Drug of choice for prophylaxis?

Amoxicillin

If allergic use clindamycin

19

Most common causes of culture negative endocarditis?

Coxiella
Batonella

20

Who gets endocarditis ppx?

Pts with both
1. Cardiac defect (prosthetic valve, previous endocarditis, heart transplant, unrelated or cyanotic heart disease)
2. Upcoming dental work or respiratory surgery

MVP not an indication!!

21

Most common causes of culture negative endocarditis?

Coxiella
Batonella

22

Who gets endocarditis ppx?

Pts with both
1. Cardiac defect (prosthetic valve, previous endocarditis, heart transplant, unrelated or cyanotic heart disease)
2. Upcoming dental work or respiratory surgery

MVP not an indication!!

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