Endocarditis

Question 1

Infection on a cardiac valve or endocardial surface within the heart

Answer 1

Infective endocarditis

Question 2

What causes most cases of infective endocarditis?

Answer 2

Bacterial infection

Fungal infections are less common

Question 3

What causes endocarditis in 50% of cases?

Answer 3

Underlying valve abnormality that provides a source of turbulent flow - transient bacteremia from procedure or surgery colonizes and leads to infection

Question 4

What causes normal valve endocarditis?

Answer 4

Bacteremia with virulent organism from an infection i.e. an IV drug user

Question 5

What bacteria commonly causes endocarditis?

Answer 5

S. aureus

Question 6

Which types of cardiac surgery do not predispose a patient to endocarditis?

Answer 6

CABG and permanent pacemakers

Question 7

What surgery is very likely to give a patient endocarditis?

Answer 7

Prosthetic heart valves

Question 8

What are the portals of entry for the bacteremia that in turn causes endocarditis?

Answer 8

Skin, oral cavity, GI tracts

Commonly from procedures or surgeries

Question 9

What types of procedures put patients at risk for endocarditis?

Answer 9

Dental work/cleaning/flossing and related procedures

Procedures and surgeries involving upper respiratory, lower GI and GU tracts

Question 10

The presence of ______ catheters put a patient at a risk for endocarditis

Answer 10

Indwelling

Question 11

Which organisms are common to cause endocarditis?

Answer 11

S aureus MOST COMMON
Strep viridans
Enterococcus fecalis
Group D strep

HACEK organisms:
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

Question 12

If a patient has prosthetic valve endocarditis and is sick within the 1st 2 months, what is the most likely organism?

Answer 12

S aureus
S epidermitis
Gram - organisms

Question 13

If a patient has prosthetic valve endocarditis becomes sick later on, what are the likely organisms?

Answer 13

Staph or strep

Question 14

Which valves are the most commonly infected with endocarditis?

Answer 14

Mitral and aortic valve

Question 15

Mass of platelets, fibrin, colonies of bacteria and a few inflammatory cells

Answer 15

Vegetation

Question 16

What is the classic valve lesion?

Answer 16

Vegetation

Question 17

Which valve is more effected in RV endocarditis?

Answer 17

Tricuspid more often than pulmonic

Question 18

Where is the only setting that RV endocarditis is found? What is the common organism?

Answer 18

Only in setting of IV drug abuse; S aureus

Question 19

What is the study of choice to diagnose endocarditis?

Answer 19

TEE - Transesophageal echocardiography

Question 20

What are the clinical findings associated with endocarditis?

Answer 20

1. Febrile illness with nonspecific symptoms
2. Infectious emboli
3. New or changing regurgitant heart murmurs may be present
4. Peripheral lesions
5. Immunologic lesions

Question 21

What are the symptoms associated with infectious emboli?

Answer 21

Stroke, flank pain, arthritis, cough/dyspnea, abscesses, organ infarction, abd pain

Question 22

What are examples of peripheral lesions from micro emboli?

Answer 22

Petechiae and subungal

Question 23

What are the immunologic lesions you might find on a patient with endocarditis?

Answer 23

Olsers nodes
Janeway lesions
Roth spots

Question 24

Exudative lesions in the retina

Answer 24

Roth spots

Question 25

Painless red lesions of palms or soles

Answer 25

Janeway lesions

Question 26

Painful, raised lesions of fingers/tos

Answer 26

Osler's nodes

Question 27

Which bacteria is likely to cause endocarditis that has an acute course with rapidly progressive, destructive infection Acute febrile illness, early embolization, valvular destruction, and insufficiency

Answer 27

Staph aureus

Question 28

Which bacteria is likely to cause a sub-acute course of endocarditis that lasts for weeks at at time Systemic and peripheral manifestations predominate with gradual valvular destruction

Answer 28

Strep viridans, enterococcus

Question 29

What diagnostic studies do you order if you suspect your patient has endocarditis?

Answer 29

Blood cultures: Draw a set of 3 one hour apart from each other before considering abx CBC: Look for leukocytosis or anemia UA: Look for hematuria

Question 30

What is the pathognomonic finding for endocarditis?

Answer 30

Finding a vegetation on TEE

Question 31

What are the major duke criteria for diagnosing endocarditis?

Answer 31

2+ BC's with typical organisms Abnormal echo or vegetation or similar new regurgitant murmer

Question 32

What are the minor duke criteria for diagnosing endocarditis?

Answer 32

Predisposing condition: Valve abnormality or IV drug use Fever Vascular phenomenon Immunologic lesion +BC not meeting above criterion

Question 33

Using the Modified duke criteria, what is a DEFINITE diagnosis of endocarditis?

Answer 33

2 major criteria 1 major + 3 minor 5 minor

Question 34

What will you hear on auscultation of the heart that will be severe due to destruction of valves?

Answer 34

Aortic regurgitation Mitral regurgitation Tricuspid regurgitation

Question 35

What would heart failure result from in a patient with endocarditis?

Answer 35

Left sided valvular regurgitation (AR, MR)

Question 36

What cerebrovascular damage are your patients at a risk for due to endocarditis?

Answer 36

Stroke from emboli traveling to brain

Question 37

What are the 3 cases where you should DEFINITELY prescribe abx prophylaxis for a patient undergoing surgery?

Answer 37

1. Prosthetic heart valves 2. Prior episode of endocarditis 3. Unrepaired or completely repaired complex cyanotic congenital heart disease

Question 38

Why do other valvular lesions (congenital or acquired) not require endocarditis prophylaxis?

Answer 38

Risk of endocarditis out-weighed by risk of side effect or reaction to antibiotic

Question 39

What should treatment of endocarditis be based on?

Answer 39

Organism identified by blood cultures