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Infective Endocarditis Flashcards

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1
Q

What is infective endocarditis?

A

A very serious microbial endocardial infection with high mortality rates

Requires a high degree of clinical suspicion for early diagnosis.

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2
Q

Who is at risk for infective endocarditis?

A

All children of any age with CHD or Rheumatic conditions

The risk is highest with a pressure gradient, small sized lesions, and less fibrosis.

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3
Q

What two factors are needed for endocarditis to occur?

A
  • Bacteremia
  • Abnormal heart
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4
Q

What is the most common organism causing infective endocarditis?

A

Streptococcus viridans

Accounts for 50% of cases.

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5
Q

What is the second most common organism associated with infective endocarditis?

A

Staphylococcus aureus

Can infect even a normal heart.

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6
Q

What organisms belong to the Coagulase Negative Staphylococci (CONS) group?

A

Coagulase Negative Staph

May follow central line insertion.

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7
Q

Which fungal organism is associated with infective endocarditis in immunosuppressed patients?

A

Candida albicans

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8
Q

What are the HACEK organisms?

A
  • Haemophilus
  • Actinobacillus
  • Cardiobacterium
  • Eikenella
  • Kingella

Associated with infective endocarditis in neonates.

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9
Q

What procedures are risk factors for developing infective endocarditis?

A
  • Dental procedures
  • Tonsillectomy
  • Cardiac surgery (open-heart surgery)
  • Genitourinary surgery
  • Central venous catheter insertion
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10
Q

What congenital heart diseases are associated with infective endocarditis?

A
  • VSD
  • PDA
  • TGA
  • F4

ASD secundum is not included.

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11
Q

What rheumatic valvular diseases are associated with infective endocarditis?

A
  • Mitral regurgitation
  • Aortic regurgitation
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12
Q

What factors increase the risk of infective endocarditis related to previous medical history?

A
  • Prosthetic valve
  • Previous infective endocarditis
  • Surgical shunts
  • Residual defect
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13
Q

What causes damage to the endothelium in the pathophysiology of certain cardiac conditions?

A

Turbulence of blood flow across stenotic or incompetent valves damages the endothelium

This damage can lead to the formation of thrombi.

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14
Q

What forms when circulating bacteria adhere and grow in thrombi?

A

Vegetations

These vegetations can lead to local valve destruction and embolization.

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15
Q

What are the potential embolic phenomena associated with vegetations?

A

Septic embolic phenomena:
* Osteomyelitis
* Meningitis
* Glomerulonephritis

These complications can arise from the embolization of vegetations.

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16
Q

What immunological response occurs in the pathophysiology discussed?

A

Deposition of immune complexes leading to vasculitis and rash

This response can contribute to the clinical manifestations.

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17
Q

In which patients should prolonged fever (> 2 weeks) be suspected as a sign of underlying cardiac issues?

A

Any cardiac patient with unexplained prolonged fever

This symptom is a key indicator in the clinical picture.

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18
Q

What are some specific skin manifestations associated with this condition?

A

Petechial rash, Janeway lesions, Osler’s nodules

Janeway lesions are painless with a necrotic center, while Osler’s nodules are small and painful.

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19
Q

What is a Janeway lesion?

A

Painless hemorrhagic lesion with necrotic center on the palms

Janeway lesions are associated with infective endocarditis.

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20
Q

What is the characteristic of a Roth spot?

A

Retinal hemorrhage with clear center

Roth spots can indicate embolic events affecting the eyes.

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21
Q

What are the symptoms of pulmonary embolism as a result of embolic phenomena?

A

Cough, dyspnea, hemoptysis & chest pain

These symptoms arise from obstruction in the pulmonary circulation.

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22
Q

What can be a consequence of renal embolism?

A

Hematuria

This occurs due to blockage of renal blood flow by emboli.

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23
Q

What are common neurological complications associated with embolic manifestations?

A

Stroke (hemiplegia, convulsions) or Intracranial hemorrhage

These complications arise from cerebral embolization.

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24
Q

What might indicate peripheral vessel involvement in embolic phenomena?

A

Absent peripheral pulsations (Dorsalis pedis or Radial pulse)

This can lead to conditions such as digital gangrene.

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25
True or False: Splinter hemorrhages are linear hemorrhages under the nail bed.
True ## Footnote This is a classic sign associated with embolic events.
26
Fill in the blank: The separation of vegetations can lead to _______ manifestations.
Embolic ## Footnote This highlights the potential distant effects of local vegetations.
27
What are the three key symptoms of acute heart failure?
Tachycardia, Tachypnea, Tender enlarged liver ## Footnote These symptoms are referred to as 3T.
28
What change may occur in the character of an old murmur due to more damage?
Change in character of old murmur ## Footnote This can indicate worsening of the underlying lesion.
29
What is a seagull murmur indicative of?
Rupture of the cusps ## Footnote This is a new murmur that may appear in certain cardiac conditions.
30
What are vegetations in the context of cardiac affection?
Small inflammatory masses: fibrin, platelets, cells and bacteria ## Footnote These occur after more than 2 weeks.
31
What is a osler nodules lesion?
Raised, small & painful lesions on the finger tips ## Footnote These are associated with infective endocarditis.
32
What is splenomegaly?
Enlargement of the spleen ## Footnote This can occur due to various infections or conditions.
33
What is the significance of blood cultures in investigations?
Very important for diagnosing infections ## Footnote Cultures should be taken before starting antibiotics and from multiple sites (3-5 cultures).
34
What type of anemia is typically found in blood pictures related to cardiac affection?
Normocytic normochromic anemia ## Footnote This may occur alongside leukocytosis due to bone marrow inhibition.
35
What does an increased ESR and positive CRP indicate?
Inflammation in the body ## Footnote These are nonspecific markers of inflammation.
36
What is the importance of echocardiography in cardiac investigations?
Can detect vegetation, old lesions & new lesions ## Footnote It can be performed trans-thoracic or trans-esophageal, especially if a prosthetic valve is present.
37
What is a CT brain used for in cardiac investigations?
To check for brain embolism ## Footnote It may show hypodense areas indicative of infarction.
38
What does a fundus examination detect in cardiac conditions?
Retinal hemorrhage ## Footnote This can be a sign of embolic events.
39
What findings might a chest radiograph show in cases of pulmonary issues?
Bilateral infiltrates, nodules, pleural effusions ## Footnote These findings can suggest pulmonary embolism or other complications.
40
What is the purpose of abdominal ultrasound in cardiac affection?
To check for renal or splenic affection ## Footnote This is important if there are signs of organ involvement.
41
What is assessed with Doppler investigations?
Vascular obstruction ## Footnote This can help diagnose issues related to blood flow.
42
What are the major criteria for diagnosing infective endocarditis according to the Duke criteria?
1. Positive blood culture: * Typical organism including streptococci or staph or HACEK group * 2 positive cultures drawn > 12 hours apart for other organisms consistent with lE 2. Positive Echocardiography: Evidence of endocarditis * New vegetation or abscess * New valve regurge or variation in the degree of already present regurge ## Footnote Major criteria are essential for a definitive diagnosis of infective endocarditis.
43
What is considered a positive blood culture in the context of infective endocarditis?
Typical organism including streptococci or staph or HACEK group ## Footnote Atypical organisms can also be considered if there are 2 positive cultures drawn > 12 hours apart.
44
What constitutes a positive echocardiography finding for infective endocarditis?
Evidence of endocarditis * New vegetation or abscess * New valve regurge or variation in the degree of already present regurge ## Footnote Echocardiography is crucial for visualizing changes in the heart that indicate endocarditis.
45
What are the minor criteria for diagnosing infective endocarditis?
1. Fever > 38 C 2. Positive blood culture for atypical organisms (single culture) 3. Predisposing factors 4. Vascular Embolic manifestations: * Cerebral infarction or hemorrhage * Retinal infarction or Conjunctival hemorrhage * Splenic infarctions * Renal infarction * Necrotic skin lesions or gangrene * Janeway lesions 5. Immune complex deposition: * Glomerulonephritis * Roth spots * Splinter hemorrhage * Osler nodules * Skin Petechiae ## Footnote Minor criteria help in the assessment when major criteria are not fully met.
46
What does 'definite infective endocarditis' mean according to the Duke criteria?
Two major criteria, or one major + three minor criteria, or five minor criteria ## Footnote This classification is critical for confirming the diagnosis.
47
What indicates 'possible infective endocarditis' according to the Duke criteria?
One major + one minor criteria, or three minor criteria ## Footnote This classification assists in identifying cases that may require further investigation.
48
True or False: A positive blood culture for atypical organisms is a major criterion for diagnosing infective endocarditis.
False ## Footnote A positive blood culture for atypical organisms is considered a minor criterion.
49
Fill in the blank: A positive echocardiography finding for infective endocarditis includes new _______ or abscess.
[vegetation] ## Footnote Vegetation refers to an abnormal growth on the heart valves indicative of infection.
50
What is a characteristic feature of Osler nodules?
They occur on the pulps of fingers or toes ## Footnote Osler nodules are painful and are indicative of immune complex deposition in infective endocarditis.
51
What is the most important factor for the prevention of infective endocarditis?
Good oral hygiene ## Footnote Good oral hygiene is emphasized as a very important aspect of prevention.
52
What is the recommended dosage of oral amoxicillin for prevention before dental procedures?
50 mg/kg as a single large dose one hour before the procedure ## Footnote This dosage is specifically for dental procedures.
53
What supportive treatment is recommended until heart failure is controlled?
Bed rest ## Footnote Bed rest is recommended until the heart failure is managed and the ESR becomes normal.
54
What dietary restrictions should be considered if a patient has congestive heart failure?
Salt and fluid restriction ## Footnote This is important to manage fluid retention in congestive heart failure.
55
What type of medication is recommended for fever in supportive treatment?
Antipyretics ## Footnote Antipyretics help manage fever associated with infections.
56
What is the initial treatment approach for infective endocarditis until culture results are available?
Empirical therapy ## Footnote Empirical therapy is provided based on clinical suspicion before specific cultures are available.
57
What combination of antibiotics is recommended for suspected methicillin-resistant S. aureus (MRSA)?
Vancomycin + Gentamycin ## Footnote This combination is used for suspected MRSA infections.
58
What is the treatment regimen for Streptococcus viridans or Enterococci infections?
Penicillin G or ampicillin or ceftriaxone for 4 weeks and Gentamycin for 2 weeks ## Footnote This regimen is specified for these bacterial infections.
59
What is the recommended treatment for Staphylococcus aureus infections?
Vancomycin for 6 weeks AND Gentamycin for 5 days ## Footnote This treatment addresses the duration and combination of antibiotics for Staphylococcus aureus.
60
What is the treatment for HACEK organisms?
Ceftriaxone alone or ampicillin + gentamycin for 4 weeks ## Footnote Vancomycin is used if penicillin or ceftriaxone are not tolerated.
61
What is the treatment for fungal infections related to infective endocarditis?
Amphotericin B ## Footnote Amphotericin B is specifically indicated for fungal infections.
62
What surgical interventions may be necessary for infective endocarditis?
Removal of vegetation & valve replacement ## Footnote Surgery is considered in cases of progressive heart failure, prosthetic valve, peri-valvular abscess, large vegetation > 10 mm, or fungal infections.
63
What is the recovery rate for patients with infective endocarditis?
80% ## Footnote This indicates a favorable prognosis for many patients.
64
2 factors needed for endocarditis
Bacteremia , abnormal heart
65
Infect endo commonest organism الاشهر
Streptococcas viridans Alpha hemolytic streptococci
66
Infect endo الاخطر
Staph au
67
Infect endo neonates
Hacek
68
Ifect endo in immuno compromised
Candida
69
Organsims causing infective endocarditis
الاشهر strept الاخطر الstaph Neonates hacek Immunocompromised candida Cons
70
What inc risk in infective nedocarditis
Inc pressure gradient Small size Less fibrosis
71
What rhematic valvular dx has more risk to infective ndocarditis
Mr ar
72
At tof does vsd has infective endo
No bec it is big
73
Which is more prone to infective endo vsd or asd
Vsd due to pressure gradient
74
Any cardiac patient with unexplained prolonged fever more than 2 weeks
Suspect infective endocarditis
75
Splenic affection in infective endocarditis
Splenooooomeglay Infarction Ancess
76
Mentio cp of heart incase of infective endocarditis
77
Vegetation components
Fibirn pt cells bacr
78
Segull murumr cuasr
Rupture of cusps
79
Embolic manifestions of infective endocarditis
80
Hand examination in case of infective endocarditis
81
Routes for infective endo
Dental , tonsillectomy من فوق Gentio urinary من تخت Cardiac surgry or catherter قلب
82
Lesions causing infective endocarditis
Chd Rhd Prothestic
83
Why at tof infective endocarditis
Due to pulmonory stenosis Whic is muscular not fibroisi And vsd not due to kbeeeeer awy
84
Mention inv of infective endometriosis
85
How many blood cultures needeed at infective endocarditis and why
3-5 bec if anything happens patient dies
86
Criteria of anemia caused by toxemia
Normocytic normochromic with leukocytodis
87
Most imp type of echo ised in infective endocarditis
Tee
88
Toxemia manifest
FAHMA +4t
89
Dukes criteria
90
Typical organisms of infective endo
Strept Staph Hacek
91
How to confrim infective endocarditis using dukes criteria
92
How brain embolism appear in ct
Hypodense area
93
Retinal hemorrage with pale center
Roth spots
94
Raised small painful nodules under nail tips
Osler nodule
95
Paineless hemoorragic lesions with necrotic center on plams
Janeway lesion
96
Does surgery is good prognosis for infective endocarditis
No carries high mortality rate due to infections
97
Most important prevention for infective endocarditis
Oral hygiene
98
Immune complex deposition manifestions
GN Roth spots Splinter hgh Osler nodule Skin petichiae
99
Prevention for oral lr esophageal prosdeure
Single amoxicilin before procedure
100
Describe ttt plan for infective endocarditis
101
Pathophydiology of ie
102
Duration of bed rest
Untill hf is controlled
103
Only exceprion for abs durstion in infective endocarditis and why
Gentamycin for 2 weeks bec ototoxic nephrotoxic

Cardio Ped (10 decks)

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