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CARDIO > Endocarditis > Flashcards

Endocarditis Flashcards

1
Q

what is endocarditis

A

infection of endothelium of heart valves

valve inflammation

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2
Q

what are the risk factors for endocarditis

A

heart valve abnormality (calcification in elderly, congenital heart disease, post rheumatic fever), prosthetic heart valve
IV drug users
IV lines

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3
Q

what is the cause of endocarditis

A

1) infection with organism
2) damaged endothelium causes platelet and fibrin deposition, organism grows (infected vegetation)
3) non laminar flow

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4
Q

what valves are most commonly affected in endocarditis

A

mitral (then aortic)

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5
Q

what valves are most commonly affected in IV drug users endocarditis

A

right sided eg. tricuspid

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6
Q

what are the 2 types of endocarditis

A

infectious and non infectious

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7
Q

what are the complications of endocarditis (organism vegetation in valve)

A

abscess or haemorrhage

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8
Q

what people commonly present with endocarditis

A
  • Rheumatic heart disease, complicates this disease
  • prosthetic valves,
  • congenital defects,
  • MV prolapse,
  • calcific disease
  • IV drug abusers
  • Older
  • Diabetic mellitus
  • Septicaemia
  • Poor dental hygiene
  • Hospital acquired (staph aureus)
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9
Q

what is the most common organism causing endocarditis

A

staphylococcus aureus

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10
Q

what are the 4 organism causing endocarditis native valve

A 
staph aureus (38%)
viridians streptococci (31%)
enterococcus sp (8%)
staph epidermidis (6%)
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11
Q

what organism causes endocarditis through skin infection

A

staph epidermis (coagulase negative)

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12
Q

other than staph epidermis what is another skin contaminant

A

Corynebacterium sp. (diptheroids)

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13
Q

what organism commonly infects prosthetic material eg. IV line infection or prosthetic heart valve

A

staph epidermidis

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14
Q

what atypical cause endocarditis

A 
o	Bartonella
o	Coxiella burnetti (Q fever)
o	Chlamydia
o	Legionella
o	Mycoplasma 
o	Bruella
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15
Q

what organism causes endocarditis in IV drug users

A

staph aureus (they also get septic PE)

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16
Q

what organism causes acute endocarditis

A

staphylococcus

skin infection

17
Q

what organism causes subacute endocarditis

A

streptococcus viridians

heart valves

18
Q

what Gm-ve organisms cause endocarditis

A 
	Hamophilus
	Actinobacillus
	Cardiobacteria
	Eikenella
	Kingella
19
Q

what are the complications of endocarditis

A 
heart failure
renal failure
Abscess, fistula, pericarditis 
Brian haemorrhage
Stroke 
Septic shock
20
Q

symptoms of endocarditis

A
  • Fever
  • Malaise
  • Tiredness
  • breathlessness
21
Q

signs of endocarditis

A
  • Sepsis/septicaemia
  • Cardiac failure
  • Osler nodes
  • Janeway lesions
  • Roth spots
  • Spliner haemorrhages
  • Systemic septic embolic: brain, kidney
  • Mycotic aneurysms
  • Finger clubbing
  • Murmur
  • Embolic event
  • Haematuria (microscopic), glomerulonephritis, renal infarction
  • Fever
  • Splenamegaly
22
Q

how is endocarditis diagnosed

A

blood cultures

for atypical: blood culture, serology, immunohisotchdemistry, PCR

23
Q

treatment of native valve endocarditis due to strep viridans

A

amoxicillin + gentamycin IV

24
Q

what should be used to treat endocarditis if penicillin allergic

A

vancomycin

25
Q

what is the treatment of prosthetic valve endocarditis (MRSA)

A

o Vancomycin + gentamycin (IV)
o Add in day 3-5 rifampidn PO
o Often valve replaced

26
Q

treatment of IV drug users endocarditis (MSSA)

A

IV flucloxacillin

27
Q

treatment of staphylococcus aureus

A

IV fluclocacillin

28
Q

treatment of enterococcus

A

Amoxicillin/vancomycin + gentamycin

29
Q

treatment of staphylococcus epidermis

A

vancomycin + gentamicin IV + rifampicin PO

30
Q

what organisms can be treated with OPAT (out parenteral antibiotic therapy_

A

streptococci or strep bovis only in stable patient

31
Q

what are the causes on non-infectious endocardits

A

rheumatic fever
SLE
non-bacterial thrombic endocarditis
carcinoid disease

32
Q

what is cardinoid disease

A

neoplasm of neuroendocrine cells in GI mucosa, carcinoid syndrome (= liver metastases)
excess 5HIAA, serotonin, histamine, bradykinin

33
Q

signs of carcinoid heart disease

A

skin flushing

nausea, vomitting, diarrhoea

34
Q

what does carcinoid heart disease cause

A

right sided cardiac valve disease

tricuspid + pulmonary insufficiency

35
Q

what is non-bacterial thrombotic endocarditis

A 
marantic endocardits (cancer)
non invasive
doesn't destroy valves 
mutinous adenocarcinoma
hypercoaguable states
36
Q

what are laneway lesions/osler’s nodes a sign of

A

subacute bacterial endocarditis

37
Q

what are the Minor FIIVE classification of endocarditis

A

Fever >38 oC
IV drug user or predisposing heart condition, and
Immunological phenomena (eg Osler’s nodes, Roth’s spots)
Vascular phenomena, e.g. mycolytic aneurysm/Janeway L’s
Echocardiograph findings

38
Q

what is the main investigations for endocarditis

A 
B: 3 separate positive blood cultures from 3 peripheral sites
B: bloods for ananemia
U: urinalysis, microscopic haematuria
CxR
Echo (transosophageal/transthoracic)
39
Q

what is the treatment of  Native valve severe sepsis and risk factors for resistant pathogens

A

vancomycin IV + meropenem IV

CARDIO (14 decks)

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