Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Valvular Heart Disease > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

(72 cards)

Start Studying
1
Q

What is endocarditis?

A

Inflammation of the cardiac endocardium affecting valves, mural endocardium, or implanted devices

It can be secondary to infection or a noninfectious process.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How many new cases of infective endocarditis are diagnosed each year in the United States?

A

10,000–15,000 new cases

Incidence varies from 0.6 to 11.6 cases per 100,000 person-years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the male to female ratio for infective endocarditis cases?

A

> 2:1

The incidence is higher in men than women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the median age at diagnosis for infective endocarditis?

A

Increasing over the years, primarily affecting patients above the age of 60

Majority of cases occur in older adults.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are common risk factors for developing infective endocarditis?

A
  • Prior structural heart disease
  • Intravenous drug use (IVDU)
  • Poor dentition/dental infection
  • Intravascular catheter/device presence
  • Immunocompromised state (e.g., HIV)
  • Invasive procedures

About ¾ of patients with IE have prior structural heart disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What percentage of infective endocarditis cases are healthcare-associated?

A

Approximately 23–27%

Includes cases related to intravascular catheters and devices.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the mortality range for patients diagnosed with infective endocarditis?

A

18 to 23% in-hospital mortality

6-month mortality is reported to be 22–27%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What factors contribute to poor outcomes in infective endocarditis?

A
  • Female gender
  • Diabetes mellitus
  • Low serum albumin
  • Poor surgical candidacy

Prognosis varies with specific conditions of IE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

True or False: The incidence of infective endocarditis has changed significantly in recent decades.

A

False

Despite improvements in diagnosis and treatment, the incidence has remained relatively stable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the traditional classifications of endocarditis?

A
  • Acute
  • Subacute
  • Chronic

Classification also includes native vs. prosthetic valve endocarditis and endocarditis associated with intravenous drug use.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which organism is now the most prevalent cause of infective endocarditis?

A

Staphylococcus aureus

This shift is due to a decline in rheumatic heart disease and an increase in nosocomial infections.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What type of endocarditis is commonly associated with intravenous drug use (IVDU)?

A

Right-sided endocarditis

This type often occurs in individuals with no prior structural heart disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the typical mortality rate for infective endocarditis caused by Staphylococcus aureus?

A

~40%

Particularly high in cases involving prosthetic valves.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the role of damaged valve endothelium in the pathogenesis of endocarditis?

A

Increases susceptibility to bacterial adherence and infection

Damage can be due to turbulent blood flow, trauma, and chronic inflammation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Fill in the blank: The majority of vegetations in infective endocarditis form on the _______ aspect of valves.

A

low pressure

Typically occurs on the atrial surface of the mitral valve and ventricular surface of the aortic valve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some common microbiological causes of infective endocarditis?

A
  • Staphylococcus aureus
  • Coagulase-negative staphylococci
  • Viridans group streptococci
  • Enterococcus species
  • HACEK group

Table 3.1 provides detailed microbiologic etiology.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which organism is associated with gastrointestinal disorders in infective endocarditis cases?

A

Streptococcus gallolyticus

Up to 60% of patients with this organism may have bowel adenoma or carcinoma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What complications are frequent in infective endocarditis caused by coagulase-negative staphylococci?

A

Heart failure (>40%) and substantial mortality (approximately 25%)

This organism is often associated with indwelling devices.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the common presentation of infective endocarditis due to viridans streptococci?

A

Subacute syndrome with symptoms lasting weeks to months

Valvular complications are less common compared to S. aureus cases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

True or False: Endocarditis due to Streptococcus pneumoniae is common.

A

False

It accounts for only 1.4% of cases and is often missed in diagnosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the significance of Enterococcus faecalis in infective endocarditis?

A

Accounts for 90% of enterococcal cases, often in elderly or debilitated patients

Frequently associated with underlying cardiac disorders or prosthetic valves.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the common cause of failure in infective endocarditis?

A

Aortic or mitral valvular involvement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which enterococcal species is the most common cause of infective endocarditis?

A

Enterococcus faecalis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What percentage of enterococcal endocarditis cases does Enterococcus faecalis account for?

A

90%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What demographic is primarily affected by enterococcal endocarditis?
The elderly and debilitated individuals.
26
What proportion of enterococcal endocarditis cases are healthcare-associated?
25%.
27
What is the mortality rate range for enterococcal endocarditis?
11 to 18%.
28
What does HACEK stand for?
A group of fastidious, gram-negative bacteria.
29
What is the prevalence of HACEK organisms in infective endocarditis cases?
About 1.4%.
30
Which organisms are included in the HACEK group?
* Haemophilus parainfluenzae * Aggregatibacter actinomycetemcomitans * A. aphrophilus * A. paraphrophilus * A. snegnis * Cardiobacterium hominis * C. valvarum * Eikenella corrodens * Kingella kingii * K. denitrificans.
31
What is the typical demographic for HACEK infections?
Younger individuals.
32
What is the mortality rate for endocarditis caused by HACEK organisms?
4%.
33
What are common causes of non-HACEK gram-negative bacilli infective endocarditis?
Members of Enterobacteriaceae and Pseudomonas spp.
34
What percentage of infective endocarditis cases occur on native versus prosthetic valves?
40% on native valves and 60% on prosthetic valves.
35
What is the range of cases of fungal endocarditis among all cases?
2–4%.
36
What are some host risk factors for fungal endocarditis?
* Parenteral drug abuse * Indwelling vascular catheters * Prosthetic devices * Compromised immune system.
37
What is the most frequently implicated fungus in endocarditis?
Candida spp.
38
What are the two types of Candida spp. commonly involved in endocarditis?
* C. albicans * Non-albicans Candida.
39
What is a common challenge in diagnosing Aspergillus infective endocarditis?
Infrequency of positive blood cultures.
40
What percentage of endocarditis cases remain unidentified despite advanced diagnostic techniques?
5–10%.
41
What factors can lead to culture-negative cases of endocarditis?
* Previous antibiotic therapy * Fastidious organisms * Organisms that cannot be grown using conventional techniques.
42
What are the four cardinal Oslerian manifestations of infective endocarditis?
* Persistent bacteremia or fungemia * Active valvulitis * Large-vessel embolic events * Immunologic vascular phenomena.
43
What is the most common symptom present in patients with infective endocarditis?
Fever.
44
What percentage of patients with infective endocarditis experience fever?
80–90%.
45
Which patients are less likely to present with fever in infective endocarditis?
Elderly and immunocompromised patients.
46
What are common nonspecific symptoms of infective endocarditis?
* Fatigue * Weight loss * Malaise * Chills * Night sweats * Arthralgias * Myalgias.
47
What physical exam findings are indicative of infective endocarditis?
* New or changing murmurs * Signs of congestive heart failure.
48
What are Osler's nodes?
Small, tender, violaceous subcutaneous nodules.
49
What are Janeway lesions?
Non-tender, erythematous skin lesions resulting from septic emboli.
50
What is the diagnostic criteria used for infective endocarditis?
The Duke criteria.
51
What is needed for a definitive diagnosis of infective endocarditis according to the Duke criteria?
Pathological evidence or clinical evidence including two major criteria or one major criterion and three minor criteria.
52
What is the recommended number of blood cultures to obtain for suspected infective endocarditis?
Three separate sets.
53
What are common laboratory findings in patients with infective endocarditis?
* Anemia * Elevated ESR * Elevated CRP.
54
What imaging technique is central to the diagnosis and management of infective endocarditis?
Echocardiography.
55
What is the first echocardiographic method performed in suspected infective endocarditis?
Transthoracic echocardiography (TTE).
56
What echocardiographic method is indicated for better image quality in suspected infective endocarditis?
Transesophageal echocardiography (TEE).
57
What is the hallmark lesion of infective endocarditis (IE)?
Vegetation ## Footnote Typically presents as an oscillating mass attached to a valvular structure.
58
Under what circumstances may transthoracic echocardiography (TTE) be considered sufficient?
Good-quality negative TTE with low clinical suspicion ## Footnote Negative echocardiography should prompt repeat studies if suspicion for IE is high.
59
What are the three most frequent and severe complications of infective endocarditis?
* Heart failure * Perivalvular extension of infection * Embolic events
60
Which echocardiographic technique is preferred for assessing perivalvular extension and its complications?
Transesophageal echocardiography (TEE) ## Footnote TEE is more effective in diagnosing perivalvular extensions.
61
What are common sites for vegetations in infective endocarditis?
* Atrial side of the mitral valve * Atrial side of the tricuspid valve * Ventricular aspects of the aortic valve * Ventricular aspects of the pulmonic valve
62
What is the role of echocardiography in the context of embolic events?
Predicts embolic risk by assessing size, mobility, and location of vegetations ## Footnote Vegetations greater than 10 mm are at higher risk of embolism.
63
What complications can result from valve destruction in native valve infective endocarditis?
Acute regurgitation leading to heart failure ## Footnote The mechanism may involve valve perforation, torn leaflet, or flail leaflet.
64
What is the importance of multi-slice computer tomography (MSCT) in the diagnosis of infective endocarditis?
Provides high-resolution anatomic information and detects valvular and perivalvular damage ## Footnote MSCT can identify cardiac lesions and extracardiac complications.
65
True or False: Echocardiography is operator-dependent.
True
66
Fill in the blank: Significant regurgitation can be caused by _______.
Chordal rupture and flail leaflet
67
What is the role of MRI in evaluating infective endocarditis?
Evaluation of complications such as paravalvular and myocardial abscesses ## Footnote MRI is less accurate than TTE and TEE for identifying vegetations.
68
What imaging modality is used to measure metabolic activity in diagnosing infective endocarditis?
18-fluorodeoxyglucose (FDG)-PET ## Footnote Helpful in cases where TTE and TEE fail to recognize vegetations due to acoustic shadowing.
69
List at least three structural complications of infective endocarditis.
* Leaflet perforation * Abscess * Valve dehiscence
70
What echocardiographic findings suggest the diagnosis of infective endocarditis?
Vegetation on cardiac valves ## Footnote Vegetations typically occur on the low-pressure side of high-velocity jets.
71
What is the significance of valve dehiscence in prosthetic valve infection?
Leads to partial detachment of the valve ring from surrounding tissue ## Footnote This can cause rocking motion of the prosthetic valve.
72
What echocardiographic information is superiorly acquired by TTE compared to TEE?
* Left ventricular function * Severity of regurgitant lesions * Filling pressures * Pulmonary artery pressures

Valvular Heart Disease (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions