Endocarditis Flashcards
(16 cards)
New-onset murmur + fever =
endocarditis till proven otherwise on USMLE
Reactive thrombocytosis (i.e., high platelets) can occur due to x, particularly y
X = infection
Y = This is not unique to endocarditis, but it is to my observation USMLE likes endocarditis as a notable etiology for it. In other words, if you get an endocarditis question
and you’re like, “Why the fuck are platelets 900,000?” (NR 150-450,000), don’t be confused.
In endocarditis x can occur from vegetations that launch off
Hematuria from vegetations that launch off to the kidney.
Endocarditis + stroke-like episode (i.e., focal neurologic signs) =
septic embolus, where a vegetation has launched off to the brain.
Acute endocarditis definition and cause
Definition: Bacterial infection of valve in patient with no previous heart valve problem
Cause: Caused by Staph aureus on USMLE.
Valves effected in acute endocarditis
- Left-sided valves (i.e., aortic and mitral) most commonly affected because of greater pressure changes (i.e., from high to low) within left heart, resulting in turbulence that enables seeding.
- IV drug users (venous blood inoculated with S. aureus) travels to heart and causes vegetation of tricuspid valve.
Staph aureus is coagulase x
positive
Subacute endocarditis definition and cause
Definition: Bacterial infection of valve in patient with history of valve abnormality (i.e., congenital bicuspid aortic valve, Hx of rheumatic heart disease).
Cause: Caused by Strep viridans on USMLE. You need to know S. viridans is can be further broken down into: S. sanguinis, S. mutans, and S. mitis.
HY precipitating event for subacute endocarditis
Hx of dental procedure is HY precipitating event, where inoculation of blood occurs via oral cavity, thus previously abnormal valve gets seeded.
Tx endocarditis
Blood cultures before antibiotics is important for 2CK.
X confirms endocarditis diagnosis after blood cultures.
Transesophageal echocardiography (TEE)
(Transthoracic echocardiography (TTE) is not done for endocarditis.)
For 2CK, empiric treatment for endocarditis is
vancomycin, PLUS either gentamicin or ampicillin/sulbactam.
Endocarditis prophylaxis given prior to x and is usually y
X - dental procedure
y - ampicillin or a second-generation cephalosporin, such as cefoxitin.
Indications for endocarditis prophylaxis are:
1) Hx of endocarditis (obvious);
2) If there is any prosthetic material in the heart whatsoever;
3) If there is any congenital cyanotic heart disease that has not been completely repaired (if it’s been completely repaired with prosthetics, give prophylaxis);
4) Hx of heart transplant with valvular regurgitation of any kind.
Things that are not an indication for endocarditis prophylaxis are:
Highest yield point for USMLE about endocarditis prophylaxis is that mitral valve prolapse (MVP) and valve regurgitations or stenoses are not an indication. In other words, do not give prophylaxis if the patient has MVP, MR, AS, etc. In
addition, bicuspid aortic valve is not an indication.
Endocarditis associated with nosocomial UTIs. Cause?
Enterococci
