Infective Endocarditis

Question 1

What is infective endocarditis?

Answer 1

Infection of the endothelium of the heart

Question 2

What part of the heart is most likely affected by infective endocarditis?

Answer 2

Cusps of valves

Question 3

Risk factors for IE?

Answer 3

Pathological valves: aortic/mitral valve disease
Valve replacement: TAVI
Structural heart disease: CHD

Question 4

Symptoms and signs of IE?

Answer 4

FROM JANE

Fever Janeway Lesions

Roth spot Anaemia

Osler nodes Nail bed haemorrhages

Murmur Emboli

Question 5

What is criteria is used to diagnose infective endocarditis?

Answer 5

Duke’s criteria

Question 6

Major criteria of Duke’s?

Answer 6

Blood cultures:
- Typical organism in 2 separate cultures
Persistently +ve blood cultures e.g. 3 >12h apart
- Single +ve blood culture for Coxiella burnetii


Endocardium:
- +ve echo (vegetation, abscess, dehiscence)
- New valvular regurgitation

Question 7

Minor criteria of Duke’s?

Answer 7

+ve blood culture that does not meet major criteria
Fever >38 degrees
Immunological phenomena e.g. Osler’s nodes, Roth spots
Vascular phenomena e.g. Janeway lesions
Risk factor

Question 8

Duke’s criteria is met if

Answer 8

2 major
1 major + 3 minor
All 5 minor
+ve histology or culture from pathological material

Question 9

Duke’s criteria is met if

Answer 9

2 major
1 major + 3 minor
All 5 minor
+ve histology or culture from pathological material

Question 10

Management of IE?

Answer 10

Initial empirical therapy with IV antibiotics, then more specific therapy