FN: Infective Endocarditis

Question 1

Definition

Answer 1

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

Question 2

Risk factors

Answer 2

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)

Question 3

Aetiology

Answer 3

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

Question 4

Culture +ve

Answer 4

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

Question 5

Culture -ve

Answer 5

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

Question 6

Non-infective

Answer 6

SLE

Marantic

Question 7

Clinical FEatures

Answer 7

Sepsis
Cardiac
Embolic phenomena
Immune complex deposition

Question 8

Sepsis signs

Answer 8

Fever, rigors
Night sweats
Wt. loss
Anaemia
Splenomegaly
Clubbing

Question 9

Cardiac

Answer 9

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

Question 10

Ebolic phenomena

Answer 10

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

Question 11

Immune complex deposition

Answer 11

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

Question 12

Roth spots

Answer 12

Boat-shaped retinal haemorrhages with pale centre

Question 13

Janeway lesions

Answer 13

Painless palmer macules

Question 14

Oslers nodes

Answer 14

Painful, purple papules on finger pulps

Question 15

Diagnosis criteria

Answer 15

Dukes criteria

Question 16

Major criteria

Answer 16

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

Question 17

Minor dukes criteria

Answer 17

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

Question 18

Minor dukes criteria

Answer 18

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

Question 19

Diagnosis if

Answer 19

2 major
1 major + 3 minor
All 5 minor

Question 20

Ivestigations

Answer 20

Blood
Urine
ECG
Echo

Question 21

Bloods

Answer 21

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

Question 22

Urine shows

Answer 22

Micro haematuria

Question 23

ECG shows

Answer 23

AV blovk

Question 24

Echo shows

Answer 24

TTE detects vegetations >2mm

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

Question 25

Treatment empiric

Answer 25

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

Question 26

Streps treatment

Answer 26

benpen + gent IV

Question 27

Enterococci

Answer 27

Amoxicillin + gent IV

Question 28

Staphs

Answer 28

Fluclox ± rifampicin IV

Question 29

Fungi

Answer 29

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

Question 30

Consider surgery if

Answer 30

HF Emboli Valve obstruction Prosthetic valve

Question 31

Prophylaxis

Answer 31

Ax prophylaxis solely to prevent IE not recommended

Question 32

Mortality

Answer 32

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