Foundations-Infective endocarditis

Question 1

Rheumatic fever

Answer 1

Systemic immune response after beta-hemolytic streptococcal infection of pharynx

Question 2

What valve is the most commonly affected in rheumatic fever?

Answer 2

Mitral valve

Question 3

Minor criteria for clinical manifestations in rheumatic fever

Answer 3

CAFE P
C-CRP elevated
A-Arthralgia
F-Fever
E-ESR elevated

P-Prolonged PR

Question 4

Major criteria for clinical manifestations in rheumatic fever

Answer 4

CANCER
Carditis/Valvulitis 
Arthritis 
Nodules (subcutaneous)
Chorea
Erythema marginatum 
Rheumatic fever

Question 5

Ddx with rheumatic fever

Answer 5

Rheumatoid arthritis
Osteomyelitis
Endocarditis
Meningitis 
SLE
Lyme disease
Sickle cell anemia

Question 6

Jones Criteria

Answer 6

Diagnosis of rheumatic fever
2 major criteria
	OR
1 major and 2 minor criteria
	OR (if recurrent)
3 minor criteria

Question 7

Rheumatic Fever Treatment

Answer 7

Supportive care- bed rest
Salicylates- Aspirin
Penicillin
Prevention of recurrences

Question 8

How many patients will develop valvulopathy after the diagnosis of rheumatic fever?

Answer 8

2/3 after 10 yrs.

Question 9

What is a poor prognosis of rheumatic fever?

Answer 9

Persistent carditis

Question 10

Complications of rheumatic fever

Answer 10

Rheumatic valve disease
Heart failure
Arrhythmias
Pericarditis w/ effusion
Rheumatic pneumonitis

Question 11

Rheumatic heart disease

Answer 11

Permanent heart valve damage subsequent to ARF

Question 12

What is the major cause of CV dz in developing nations?

Answer 12

Rheumatic heart disease

Question 13

Infective endocarditis

Answer 13

Microbial infection of valvular or endocardial surface of the heart

Question 14

How does Infective endocarditis occur?

Answer 14

Bacteria will colonize on the valve and proliferate

–>start to have damage occur to the valve

Question 15

Classifications of Infective endocarditis

Answer 15

Native valve endocarditis (own heart vavle)
Prosthetic valve endocarditis
Injection drug users

Question 16

What valve is most likely to be involved in native valves?

Answer 16

Mitral

Question 17

What valve is most likely to be involved in injection drug users?

Answer 17

Tricuspid

Question 18

What organism causes infective endocarditis?

Answer 18

Staph aureus

Question 19

What side of the heart is more likely to be involved in infective endocarditis?

Answer 19

Right side

Question 20

What physical exam finding is very telling of infective endocarditis?

Answer 20

Regurgitant murmur or new murmur

Question 21

What peripheral lesions would you expect to find with infective endocarditis?

Answer 21

Petechiae
Splinter/subungual hemorrhages 
Osler nodes
Janeway lesions
Roth spots

Question 22

What is the most important lab to test for suspected infective endocarditis?

Answer 22

Blood cultures

Question 23

Duke Major criteria for infective endocarditis diagnosis

Answer 23

1. Two positive blood cultures or persistent bacteremia
2. Echo shows evidence of endocardial involvement
3. New regurgitant murmur

Question 24

Definitive Diagnosis for infective endocarditis

Answer 24

2 major criteria
	OR
1 major criterion and 3 minor criteria
OR
5 minor criteria

Question 25

Bacterial Endocarditis FIVE PM

Answer 25

B- Blood Culture + E-Endocardial Involvement: +echo; new table regurgitation. F-Feve I-Immunologic: glomerulonephritis; Osler nodes; Roth spots; Rf V-Vascular : cutaneous hemorrhages, aneurysm, systemic emboli, pulmonary infarction E-Echocardiography findings P-Predisposition: heart condition, IV drug user M-Microbiolgic evidence

Question 26

Empiric treatment of infective endocarditis

Answer 26

Vancomycin + Ceftriaxone

Question 27

Empiric treatment of infective endocarditis in patients with a prosthetic valve

Answer 27

Vancomycin + Rifampin + Gentamicin

Question 28

Viridans streptococci treatment in complicated infective endocarditis

Answer 28

Penicillin IV or Ceftriaxone IV

Question 29

Viridans streptococci treatment in uncomplicated infective endocarditis

Answer 29

Penicillin IV or Ceftriaxone IV | + Gentamicin IV

Question 30

Viridans streptococci treatment in infective endocarditis with PV

Answer 30

Penicillin IV or Ceftriaxone IV x6 wks of + Gentamicin IV x2 wks

Question 31

Other streptococci treatment in infective endocarditis with PV

Answer 31

Penicillin IV OR Ceftriaxone IV OR Cefazolin IV

Question 32

Who do we treat prophylactically for infective endocarditis?

Answer 32

Prosthetic cardiac valve Previous IE Congenital heart disease Heart transplant w/ valvulopathy

Question 33

Cardiac conditions not needing Prophylaxis for infective endocarditis

Answer 33

``` MVP RHD Bicuspid valve disease Calcified AS Congenital heart disease – VSD, ASD, HOCM ```

Question 34

Procedures needing prophylaxis for infective endocarditis

Answer 34

1. Dental procedures that involve: - Gingival tissue - Periapical region - Perforation of the oral mucosa 2. Respiratory tract procedures that involve incision of the respiratory mucosa - Tonsillectomy - Transbronchial biopsy 3. Procedures on infected skin, skin structure, or musculoskeletal tissue - Abscess drainage

Question 35

Procedures not needing prophylaxis in infective endocarditis

Answer 35

``` Ear or body piercing Tattooing Vaginal delivery Hysterectomy Routine (non-cleaning) dental work ```

Question 36

What antibiotic would you use in prophylaxis with dental and respiratory procedures

Answer 36

Amoxicillin 2 gm PO