Endocarditis

Question 1

What valve is MC infected?
-The exception is in IVDU. In this case, what valve is the MC infected?

Answer 1

Mitral overall

Tricuspid if IVDU

Question 2

Acute Bacterial Endocarditis (infection of normal valve)
-MC organism

Answer 2

-Staph Aureus
–Also common in IVDU

Question 3

Subacute (infection of abnormal valve)
-MC organism
-What is also associated with

Answer 3

-Strep Viridans
-Associated with poor dentition or dental procedures

Question 4

IVDU-related MC organism involved

Answer 4

Staph Aureus (especially MRSA)

Question 5

Prosthetic valve endocarditis
-Early (within 60 days) MC organism
-Late (after 60 days) MC organism

Answer 5

-Early: Staph epidermis
-Late: Staph Aureus

Question 6

What organism causes endocarditis that is seen especially in men > 50 with a recent history of GI or GU procedure?

Answer 6

Enterococcus

Question 7

What is the modified Duke Criteria, what do you need to diagnose as endocarditis, and what are the components of each category?

Answer 7

-You need 2 major OR 1 major + 2 minor

-MAJOR
–2 positive blood cultures by known organism
–Endocardial involvement (either + echo or new valvular regurgitation)
-MINOR
–Fever
–Predisposing condition (IVDU, abnormal valves, indwelling catheters)
–Vascular phenomena: Janeway lesions, pulmonary emboli
–Immunologic phenomena: Osler nodes, Roth spots, + Rheumatoid Factor, acute glomerulonephritis
– + blood culture with diff organism
– + echo not meeting major criteria (worsening murmur for example)

Question 8

What are the common symptoms of endocarditis?

Answer 8

-Persistent fever (MC)
-New onset murmur or worsening or an existing murmur
-Roth spots: retinal hemorrhages with central clearing
-Osler nodes: painful nodules on pads of digits and palms
-Janeway lesions: painless macules on palms and soles
-Splinter hemorrhages: linear lesions under nail bed
-Splenomegaly
-Glomerulonephritis

Question 9

How long do you treat a patient with ABX who has endocarditis?

Answer 9

4-6 weeks

Question 10

Native Valve Treatment:

Prosthetic Valve Treatment:

Fungal Treatment:

Answer 10

-Nafcillin/Oxacillin + Ceftriaxone/Gentamicin
(Vanco if PCN allergic)

-Vanco + Gentamicin + Rifampin

-Amphotericin B (6-8 weeks)

Question 11

What diagnostic studies should you be obtaining in a patient you suspect endocarditis?

Answer 11

-Blood cultures: 3 sets at least 1 hour apart
-ECG at regular intervals
-Transesophageal echocardiogram (TEE)

Question 12

Name some patients who should get endocarditis prophylaxis and what procedures need it.

Answer 12

-Cardiac conditions: prosthetic heart valves, heart repairs (not including stents), prior history of endocarditis, congenital heart disease
-Procedures: Dental, Respiratory, Skin/MSK tissues (abscess drainage, etc.)

Question 13

What are some options for prophylaxis for endocarditis?

Answer 13

Amoxicillin 2g 30-60 minutes prior to procedure

Clindamycin 600mg if PCN allergic

Question 14

What type of endocarditis is associated with systemic lupus erythematosus (SLE)?

What is this?

Answer 14

Libman-Sacks Endocarditis

-Nonbacterial thrombotic endocarditis due to sterile platelet thrombi deposition on affected valve