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Clin Med - Cardio Exam #2 > Endocarditis > Flashcards

Flashcards in Endocarditis Deck (51)
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1

Pathologies of endocarditis

Prototypic Native Valve Endocarditis (NVE) lesion
Non-bacterial Thrombotic Endocarditis (NBTE)

2

What are NVE lesions made up of?

Mass of platelets, fibrin, microbial microcolonies with scant inflammatory cells

3

What are NBTE (AKA marantic endocarditis) made up of?

uninfected platelet-fibrin thrombus often a nidus for mocrobial adhesion during bacteremia

4

Explain the Venturi effect

NBTE and NVE develop on sides of low-pressure sink just beyond the valve or intraventricular defect or stenosis (they glob on)

5

T/F Cardiac valves have no dedicated blood supply?

T

6

What effects does the lack of dedicated blood supply have on cardiac valves?

Host immune response blunted
Limited access of abx

7

What cardiac locations are involved in endocarditis?

Native/prosthetic valves
Low-pressure side of ventricular septal deffect
Mural endocardium damaged by aberrant jets
Intracardiac devices

8

What are the 2 older terms still used in some places to classify endocarditis?

Subacute Bacterial Endocarditis (SBE)
Acute Bacterial Endocarditis

9

What is the classification system now preferred for endocarditis?

Incubation classification

10

Incubation less than about_____ is considered short incubation?

Six weeks

11

Inbuation greater than about ______ is considered long incubation?

Six weeks

12

What are the most common current etiologies of endocarditis?

Congenital heard disease
Illicit IV drug use
Degenerative Valve dz
Intracardiac devices
Incidence notability increased in elderly

13

What percent of cases of NVE are related to healthcare?

30-35%

14

What percentage of endocarditis involves prostehtic valves?

16-30%

15

during what time period is a patient with a valve replacement at greatest risk of endocarditis?

6-12 months

16

What locations on the body can serve as possible soures of infective endocarditis?

Oral cavity
skin
upper respiratory tract
GI
GU

17

What bacteria may result in endocarditis from oral cavity, skin, and upper respiratory tract?

Strep Viridans
Staphlococci
HACEK

18

What bacteria may result in endocarditis from GI source?

Strep gallolyticus
Polyps
colon tumors

19

What bacteria may result in endocarditis from a GU source?

Enterococci

20

What bacteria may result in endocarditis from a nosocomial source?

Staph aureus
CoNS (coag neg staph)
Enterococci

21

What procedures may result in procedure induced bacteremia?

Endoscopy
Colonoscopy
Barium enema
Dental Extractions!!!
Transurethral resection of prostate (TURP)
TEE

22

What is the timeline for recognizing a nosocomial infective endocarditis?

Exposure within 90 days

23

What valve is most commonly involved in endocarditis in an IV drug user? And what pathogens are most common?

Tricuspid-S. aureus, commonly MRSA

24

What percentage of patient's have negative blood cultures? What is this due to?

5-15% come back negative (33-50% of this is due to premature initiation of tx.)

25

Pathogenesis of E-carditis (4)

1. Adhesion molecules recognize MSCRAMMS
2. Platelet-fibrin vegetations form dense microcolonies of microbes
3. Organisms deep inside the vegetations are inactive and resistant
4. Surface organisms continuously shed into the blood stream

26

It is the result of ___________ that causes the symptoms of Endocarditis?

Fighting the infection

27

What symptoms result from the pathophys of endocarditis?

Constitutional - cytokine production
Damage to intracardiac structure
Embolization of veg fragments - leading to infection or infarction
Bacteremia
Tissue injury

28

cadiac presentation of E-card?

murmurs may not start right away but occur eventually in 85%
CHF (30-40%)-from valvular dysfunction
Intracardiac fistula
MI-dt emboli (2%)

29

Classic presentation seen in 50% of endocarditis pt's?

Petechiae
subungual (splinter) hemorrhages
Osler nodes
Janeway lesions
Roth spots

30

Define Osler nodes

Tender subcutaneous nodules usually distal pads of the digits