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Medicine > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

What is infective endocarditis?

A

This is a microbal infection of the heart valves, lining of the heart chamber and the blood vessels.

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2
Q

What is the incidence of Infective Endocarditis?

A

5-15 cases per 100,000 per annum

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3
Q

What percentage of IE patients are over 60yrs?

A

> 50%

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4
Q

What percentage of pesons with Rheumatic Fever develop IE

A

24%

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5
Q

What percentage of persons with congenital heart disease develops IE

A

19%

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6
Q

What is the fatality rate of bacterial endocarditis

A

20%
(increased in prosthetic valves)
(increased in anti-biotic resistant organisms)

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7
Q

List 7 groups of aetiological agents that can cause Infective Endocarditis

A 
Oral Cavity Commensals
Bowel or Urinary Tract Commensals
Skin Commensals 
Post operative
Q Fever Endocarditis
HACEK Group
Yeast and Fungi
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8
Q

Oral Commensals account for what percentage of IE cases (subacute IE that is)

A

75%

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9
Q

What group of oral commensal cause Subacute IE

A

Viridans Streptococci

Strep. Mitis

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10
Q

List 3 groups of bowel, urinary commensals that can cause Infective Endocarditis

A

Enterococcus Faecalis
E.Faecium
Strep. Bovis

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11
Q

In the event that a patient is found to have IE secondary to Strep. Bovis ( Strep. Gallolyticus) what investigation is important to be done?

A

Colonoscopy, as the patient is likely to have a large bowel malignancy

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12
Q

What is the most common cause (organism) of Acute Endocarditis

A

Staphylococcus Aureus

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13
Q

List 1 skin commensal that can cause IE (acute)

A

Staphylococcus Aureus

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14
Q

How does a skin commensal like Staph aureus get into the blood steam to cause IE?

A

Abscess
Vascular access sites
Skin infections

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15
Q

Apart from Staph. Aureus list 2 other causative agents of Acute Infective Endocarditis

A

Strep. pneumoniae

Strep. Pyogenes

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16
Q

What group of bacteria is usually the source of Infective endocarditis secondary to operation (post-op commensals)

A

Coagulase negative staphylococcus

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17
Q

List two examples of Coagulase Negative Staphylococcus

A

Staph. Epidermis

Staph. Lugdenesis

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18
Q

A patient that has a h/o conatct with farm animals, most likely has what type of infective endocarditis

A

Q Fever Endocarditis

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19
Q

Which bacteria causes Q Fever Endocarditis

A

Coxiella Bumetii

20
Q

What is the treatment for Q Fever Endocarditis

A

Lifelong antibiotics

21
Q

List the “slow growing, fastdidious, gram negative organisms, oropharyngeal commensals” that can cause Infective Endocarditis

A 
HACEK Group
H- Haemophillus Aphrophilus
A- Aggregatibacter Actino.
C- Cardiobacterium Hominis
E- Eikenella Corrodens
K- Kigella Kingae
22
Q

List 2 yeast/ fungi that can cause infective endocarditis

A

Candida
Aspergillus
(in dwelling catheters)

23
Q

List the 4 steps in the pathogenesis of infective endocarditis

A

1) Occurs at Site of Endothelial damage
2) Avascular Valve protects microb from WBCs
3) Vegetations may grow and cause obstruction or embolize
4) Adjacent tissue destroyed, abscess may form

24
Q

Why does the infection in IE usually occur at sites of endothelial damage ?

A

Because they attract deposits of platelets and fibrin that are vulnerable to colonization by microbs

25
Q

List 5 complications of IE

A 
Valve Regurgitation
Skin lesions
Vasculitis
Mycotic Aneurysm
Infarct of kidney or spleen
26
Q

What is the difference between acute and subacute Infective Endocarditis

A

Acute endocarditis can develop suddenly and become life-threatening within days while subacute endocarditis develops slowly over a period of several weeks or months

27
Q

What are the 4 factors that determine the presentation of IE

A
  • subacute/acute IE
  • Causative agent
  • Site of infection
  • presence of valve shunt or prosthesis
28
Q

Subacute Endocarditis should be suspected in a patient with Congenital Heart disease, or valvular heart disease when they experience which symptoms?

A
  • Night Sweats
  • Persistent Fever
  • Weight Loss
  • Unusual Tiredness
  • night sweats
  • new signs of valve dysfuction
29
Q

Subacute Endocarditis should be suspected in a patient with Congenital Heart disease, or valvular heart disease when they experience which signs?

A 
Splinter Haemorrhage
Purpura
Petechial haemorrhage
Osler's nodes
digital clubbing
30
Q

What is the difference between osler’s nodes and janeway lesions

A

Osler’s nodes are painful tender swellings at the fingertips while janeway lesions are rare non-tender macules on the palms and soles

31
Q

List three signs/symptoms of acute endocarditis

A

severe febrile illness
prominent changing heart murmurs
petechiae

32
Q

What are the signs of post operative IE

A

unexplained fever in a patient who has had heart valve surgery

33
Q

List three differentials for infective endocarditis

A 
Lyme Disease 
Atrial Myoxma (non cancerous tumour)
Antiphospholipid Syndrome (mistakenly attack body tissue)
34
Q

List 5 investigations done for a pt with IE

A 
Blood culture
ECG
Echocardiogram
ESR/CRP
CXR
35
Q

How is misdignosis of skin commensals avoided when taking blood cultures for IE?

A

Blood culutres taken from 2/3 different sites at 3 hr intervals.

NB// Both aerobic and anaerobic culture required

36
Q

what are three main reasons for doing an Echo in a pt with IE

A
  • detecting and following the progress of vegetations
  • detect abscess
  • assess valve damage
37
Q

List two types of Echo

A

Transesophageal (90% sensitivity)

Transthoracic (65% sensitivity)

38
Q

Which is better in assessing abscess formation and in pts with prosthetic valves, Transoesophageal or transthoracic Echocardiography?

A

Transesophageal

39
Q

True or False

Faluire to detect vegetations does not exclude diagnosis

A

True

40
Q

In infective Endocarditis, what might an ECG reading show?

A

May show the development of an AV block

41
Q

What is the empirical treatment for Subacute Infective Endocarditis?

A

amoxicillin (2g 6times daily IV)

+/- Gentamicin

42
Q

What is the empirical treatment for Acute Infective Endocarditis?

A

Vancomycin (1g bd IV) + gentamicin (1mg/kg bd IV) +Rifampicin (300-600 mg po)

43
Q

What is the empirical treatment for Infective Endocarditis caused by Enterococcus?

A

Amoxicillin + Gentamicin
If pen allergic: vancomycin + gentamicin —for 4wks (6wks if prosthetic valve);
review need for gentamicin after 2wks.

44
Q

List 5 indications for cardiac surgery in a patient with infective endocarditis

A

Heart Failure due to valve damage

Failure of antibiotic therapy

Large vegetations on left sided heart valves (high risk of emboli)

Previous evidence of systemic emboli

Abscess formation

45
Q

What is the criteria for diagnosis of infective endocarditis?

A

Duke’s Modified Criteria

  • 2 major
  • 5 minor
  • 1 major , 3 minor
46
Q

DUKE’S MODIFIED CRITERIA

List 5 major criteria.

A
  • Typical organism (Staph, Strep) from 2 cultures
  • Persistent positive blood culture >24hrs
  • 3+ positive cultures taken over 1hr
  • Positive echo findings of vegetations
  • New valvular regurgitation
47
Q

DUKE’S MODIFIED CRITERIA

List 7 minor criteria.

A
  • Predisposing valvular and cardiac abnormality
  • Pyrexia >38oC
  • Blood cultures suggestive but may not meet major criteria
  • Embolic Phenomenon
  • Vasculitis phenomenon
  • IV drug misuse
  • suggestive echo findings

Medicine (14 decks)

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