Flashcards in Endocarditis Deck (28)
What is endocarditis until proven otherwise?
Fever and new murmur
Why is endocarditis deadly?
Can cause end organ failure from emboli (heart, respiratory and kidney)
Risk factors of endocarditis?
Previous rheumatic disease
Age related valvular degeneration
IV drug use
Congenital heart disease
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
What can lead to organisms entering the blood stream?
Poor dental hygiene
IV drug use
Soft tissue infection
Name 10 acute signs and symptoms of endocarditis
Rigors and night sweats
Roth spots on retina
Cerebral embolic events (stroke/TIA)
Name 5 subacute signs and symptoms of endocarditis
Osler's nodes (tender and 3D on fingers)
Janeway lesions (flat painless)
How is endocarditis diagnosed?
Positive blood culture of typical pathogen
Vegetation/abscess seen on echo
New valvular regurgitation
+ predisposing risk factors
Treatment of endocarditis?
IV antibiotics (liase with microbiology)
Monitor (kidneys, treatment, PR interval)
Surgeons? Intensive care?
Complications of endocarditis?
Aortic root abscess
Retinal artery occlusion
Acute limb ischaemia
Instead of emboli, what could cause the osler's nodes, roth spots, splinter haemorrhages?
Immune complex formation
Acute renal failure occurs because:
Immune complex and vasculitic glomerulonephritis
Septic emboli-> infarction
Heart failure-> haemodynamic impairment
CT imaging nephrotoxicity
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
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)
What is the colour on an echo?
Colour doppler to assess flow
What % of endocarditis is culture negative?
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
What are other causes of endocarditis not usually picked up by blood culture?
How would you treat HACEK endocarditis?
Ceftriaxone or ciprofloxacin
What would serology be looking for?
What are the most common organisms?
Streptococcus (coagulase negative/viridans/bovic/other)
Treatment for chronic endocarditis?
Treatment for sever sepsis endocarditis?
Vancomycin + gentamicin
Indication for endocarditis surgery?
Prevention of embolism
Heart failure in endocarditis is caused by what?
Mitral chordal rupture/leaflet formation
Vegetation obstructing closure
What indicates uncontrolled infection in endocarditis and is an indication for surgery?
Abscess, pseudoaneurysm, fistulae
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