Endocarditis

Question 1

What is the usual cause of infective endocarditis

Answer 1

Streptococci or Negative Staphylococci

Question 2

Symptoms of endocarditis

Answer 2

1. Fever
2. Heart murmur
3. Glomerulonephritis
4. Night Sweats
5. Anaemia

Question 3

How do negative staphylococci infect the body

Answer 3

Usually present in normal oral flora but make their way into the blood via dental surgery

Question 4

What structures does endocarditis effect

Answer 4

1. Valves with congenital or acquired defects (left side of the heart)
2. Normal valves by S. pneumonia or S. aureus
3. Prosthetic valves and pacemakers

Question 5

Under what conditions can valid on the right side of the heart be infected

Answer 5

IV DRUG ADDICTS

Question 6

Where is endocarditis most common

Answer 6

Developing countries

Question 7

What gender does endocarditis effect the most

Answer 7

Males

Question 8

Most common cause of endocarditis

Answer 8

S. aureus (IVDU, diabetes and surgery)

Pseudomonas aeruginosa

S. viridian’s dental problems

Question 9

What are three characteristics of S. viridian’s that infect the endocardium

Answer 9

1. Gram positive
2. alpha haemolytic and
3. optochin resistant

Question 10

Risk factors that effect endocarditis

Answer 10

1. IV drug use
2. Poor dental hygiene
3. Skin and soft tissue infection
4. Dental treatment
5. IV cannula
6. Cardiac surgery
7. Pacemaker

Question 11

Pathophysiology

Answer 11

1. Consequence of: presence of organisms in bloodstream and abnormal cardiac endothelium that facilitates adherence and growth
2. Damaged endothelium promotes platelet and fibrin deposition which adheres to organisms leading to infected vegetation

Question 12

What calves are commonly effected

Answer 12

Aortic and mitral valves

IV drug users are exceptions

Question 13

Long-term effect on valves

Answer 13

Organisms can destroy them resulting in regurgitating or heart failure

Question 14

How does poor dental hygiene result in endocarditis

Answer 14

1. Bacteria in tooth plaque can cause gum disease = bleeding and inflammation of gums causing bacteria to enter bloodstream

Question 15

Presentation of endocarditis

Answer 15

1. New valve lesion
2. Embolic events of unknown origin
3. Sepsis of unknown origin
4. Haematuria, glumerulonehritis
5. Fever

Question 16

How does infection by S.aureus effect development of endocarditis

Answer 16

Develops very quickly and illness feels worse

Question 17

What can embolism of vegetations result in

Answer 17

Strokes, pulmonary embolisms

Question 18

When should endocarditis be excluded as a diagnosis in patients

Answer 18

With heart murmur and a fever

Question 19

Clinical manifestations of endocarditis

Answer 19

1. Haemorrhages on nail beds
2. Embolic skin lesions (black spots)
3. Osler nodes (tender nodules in digits)
4. laneway lesions (haemorrhages and nodules in the fingers)
5. Roth spots (retinal haemorrhages with white or clear centres seen on fundoscopy
6. Petechiae (small red/purple sports caused by bleeding in the skin)

Question 20

How are embolic skin lesions caused

Answer 20

Infarcts causing bits of infective vegetation blocking small capillaries

Question 21

How do we diagnose for Endocarditis

Answer 21

1. 3 sets of blood cultures from DIFFERENT sites over 24hrs
2. Take before antibiotics started

CRP + ESR raised
Normochromic/ normocytic anaemia
Neutrophilic

Urinalysis - haematuria
CXR - Cardiomegaly
ECG - long PR interval

Finally Echocardiograms

Question 22

What is the advantage of TTE echocardiogram

Answer 22

Safe, non-invasive, no discomfort

Question 23

Disadvantage of TTE

Answer 23

Poor images so low sensitivity but can identify vegetations (>2mm)

Question 24

Does a negative TTE exclude infective endocarditis

Answer 24

no

Question 25

Pros of TOE (tracheal oesophageal echo)

Answer 25

More sensitive, uncomfortable BETTER AT DIAGNOSIS - exam answer

Question 26

When do we use a TOE

Answer 26

Visualising mitral lesions and checking for development of aortic root abscess

Question 27

Treatment of all types of endocarditis

Answer 27

Antibiotic for 4-6 weeks

Question 28

treatment for non-staphylococcus bacteria

Answer 28

Penicillin (benzylpenicillin + gentamicin together to be strong enough the break cell walls)

Question 29

Treatment for staphylococcus

Answer 29

Vancomycin | Rifampicin

Question 30

Surgery to cure endocarditis

Answer 30

1. Removing valves and inserting prosthetic ones

Question 31

When is surgery used

Answer 31

1. Infection can't be cured with antibiotics 2. Remove infected devices 3. Remove large vegetations before they embolism