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Flashcards in Endocarditis Deck (28)
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1

What is endocarditis until proven otherwise?

Fever and new murmur

2

Why is endocarditis deadly?

Can cause end organ failure from emboli (heart, respiratory and kidney)

3

Risk factors of endocarditis?

Previous rheumatic disease
Age related valvular degeneration
Prosthetic valve
IV drug use
Congenital heart disease

4

Why is the normal immune response impaired?

Valve cusps are avascular
Protective layer of fibrin and platelets around vegetation means antibiotics can't reach infection

5

What can lead to organisms entering the blood stream?

Poor dental hygiene
IV drug use
Soft tissue infection
Pacemakers/cardiac surgery

6

Name 10 acute signs and symptoms of endocarditis

Fever
New murmur
Cardiac/renal failure
Rigors and night sweats
Splinter haemorrhages
Roth spots on retina
Cerebral embolic events (stroke/TIA)
Malaise
Breathlessness

7

Name 5 subacute signs and symptoms of endocarditis

Splenomegaly
Clubbing
Purpura
Osler's nodes (tender and 3D on fingers)
Janeway lesions (flat painless)

8

How is endocarditis diagnosed?

Positive blood culture of typical pathogen
Vegetation/abscess seen on echo
New valvular regurgitation
+ predisposing risk factors
+fever>38º
Immunologic/embolic signs/events
Serology/abnormal culture

9

Treatment of endocarditis?

IV antibiotics (liase with microbiology)
Monitor (kidneys, treatment, PR interval)
Surgeons? Intensive care?

10

Complications of endocarditis?

Heart failure
Aortic root abscess
AV block
MI
Stroke/renal/splenic infarcts
Retinal artery occlusion
Acute limb ischaemia
PE

11

Instead of emboli, what could cause the osler's nodes, roth spots, splinter haemorrhages?

Immune complex formation

12

Acute renal failure occurs because:

Immune complex and vasculitic glomerulonephritis
Septic emboli-> infarction
Heart failure-> haemodynamic impairment
Antibiotic toxicity
CT imaging nephrotoxicity

13

What is an echocardiogram?

High frequency sound waves to generate images of the heart and detect blood flow within the cardiac chambers and blood vessels

14

When would an echo be ordered

To investigate cardiac symptoms (breathlessness, chest pain, palpitations)
Investigate signs (murmur, raised JVP, peripheral oedema)
Investigate unwell patient (MI, heart failure, rule out PE, aortic dissection, endocarditis)

15

What is the colour on an echo?

Colour doppler to assess flow

16

What % of endocarditis is culture negative?

30%

17

What would you do if the culture came back negative?

If pt on antibiotics, consider stopping them and repeating 3 sets of blood cultures
May have to off them for 7-10 days for +ve blood cultures

18

What are other causes of endocarditis not usually picked up by blood culture?

HACEK organisms
Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella

19

How would you treat HACEK endocarditis?

Ceftriaxone or ciprofloxacin

20

What would serology be looking for?

Intracellular organisms:
Bartonella spp
Coxiella burnetii
Tropheryma whipplei
Mycoplasma spp
Legionalla spp
Brucella spp

21

What are the most common organisms?

Staph aureus
Streptococcus (coagulase negative/viridans/bovic/other)
Enterococcus
HACEK
Fungi/yeast
Polymicrobial
Culture negative

22

Treatment for chronic endocarditis?

IV amoxicillin

23

Treatment for sever sepsis endocarditis?

Vancomycin + gentamicin

24

Indication for endocarditis surgery?

Heart failure
Uncontrolled infection
Prevention of embolism

25

Heart failure in endocarditis is caused by what?

Mitral chordal rupture/leaflet formation
Vegetation obstructing closure
Intracardiac fistula

26

What indicates uncontrolled infection in endocarditis and is an indication for surgery?

Abscess, pseudoaneurysm, fistulae

27

What does the surgical treatment of endocarditis aim to do?

Debride infected tissue
Close cardiac defects
Repair valves/replace valves
Insert an aortic homograft in aortic root abscesses

28

What is the mortality of surgery for endocarditis in native valves versus prosthetic valves

5-10% native
10-20% prosthetic