FN: Infective Endocarditis Flashcards Preview

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Flashcards in FN: Infective Endocarditis Deck (32):
1

Definition

Cardiac valves develop vegetations composed of bacteria and platelet-fibrin thrombus

2

Risk factors

1. Prosthetic valves
2. Degen. valvulopathy
3. VSD, PDA, CoA
4. Rheumatic fever
5. Dental caries
6. Post-op wounds
7. IVDU (tricuspid valve)
8. Immunocomp. (inc. DM)

3

Aetiology

1. Culture +ve
2. Culture
3. Non-infective

4

Culture +ve

1. s. viridans
2. S. bovis
3. S. aureus
4. S. epidermidis
5. Enterococci
6. Pseudomonas

5

Culture -ve

1. Haemophilus
2. Actinobacillus
3. Cardiobacterium
4. Eikenella
5. Kingella
6. Coxiella
7. Chlamydia

6

Non-infective

SLE
Marantic

7

Clinical FEatures

Sepsis
Cardiac
Embolic phenomena
Immune complex deposition

8

Sepsis signs

Fever, rigors
Night sweats
Wt. loss
Anaemia
Splenomegaly
Clubbing

9

Cardiac

New/changing murmur (MR: 85%, AR: 55%)
AV block
LVF

10

Ebolic phenomena

Abscessess in brain, heart, kidney, spleen, gut and lung (if right-sided)
Janeway lesions

11

Immune complex deposition

Micro haematuria due to GN
Vasculitis
Roth spots
Splinter haemorrhages
Oslers nodes

12

Roth spots

Boat-shaped retinal haemorrhages with pale centre

13

Janeway lesions

Painless palmer macules

14

Oslers nodes

Painful, purple papules on finger pulps

15

Diagnosis criteria

Dukes criteria

16

Major criteria

1. +ve blood cultures
1a. Typical organism in 2 seperate cultures, or
b. Persistently +ve culture e.g. 3>12h apart

2. Endocardium involved
a. +ve echo (vegetation, abscess, valve dehiscence) or New valvular regurgitation

17

Minor dukes criteria

1. Predisposition: cardiac lesions, IVDU
2. Fever >39
3. Emboli: septic infarcts, splinters, Janeway lesions
4. Immune phenomenon: GN, Osler nodes, Roth spots, RF
5. +ve blood culture not meeting major criteria

18

Minor dukes criteria

1. Predisposition: cardiac lesions, IVDU
2. Fever >39
3. Emboli: septic infarcts, splinters, Janeway lesions
4. Immune phenomenon: GN, Osler nodes, Roth spots, RF
5. +ve blood culture not meeting major criteria

19

Diagnosis if

2 major
1 major + 3 minor
All 5 minor

20

Ivestigations

Blood
Urine
ECG
Echo

21

Bloods

1. N. chromic, Normocytic anaemia
2. raised ESR and CRP
3. +ve IgG RF (immune phenomenon)
Cultures x 3 >12h apart
4. Serology for unusual organisms

22

Urine shows

Micro haematuria

23

ECG shows

AV blovk

24

Echo shows

TTE detects vegetations >2mm

TOE is more sensitive (90-100% vs. 50-60%)

25

Treatment empiric

Acute severe: Fuclox + gent IV
Subacute: Benpen + gent IV

26

Streps treatment

benpen + gent IV

27

Enterococci

Amoxicillin + gent IV

28

Staphs

Fluclox ± rifampicin IV

29

Fungi

Flucytosine IV + fluconazole PO. Amphotericin if flucytosine resistance or Aspergillus

30

Consider surgery if

HF
Emboli
Valve obstruction
Prosthetic valve

31

Prophylaxis

Ax prophylaxis solely to prevent IE not recommended

32

Mortality

30% w/ staphs
14% w/ bowel flora
6% w/ sensitive streps

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