Infective endocarditis

Question 1

What are the risk factors for endocarditis

Answer 1

1. ) Prosthetic heart valve
2. ) Injection drug use
3. ) Dental procedures that cause BLEEDING
4. ) Previous endocarditis
5. ) Unrepaired cyanotic heart disease

Question 2

What symptoms must you look out for to suspect that endocarditis is present

Answer 2

Fever + new-onset murmur

Question 3

Once you determine that someone has fever and new-onset murmur for endocarditis, what is the next steps

Answer 3

Step 1: Blood cultures
Step 2: If blood cultures positive, proceed to TTE
Step 3: If TTE negative, proceed to TEE

Two positive blood cultures + positive echo = TEE

Note: HACEK organisms not on blood cultures

Question 4

What would an abnormal echo show for endocarditis

Answer 4

Valvular vegetation or abscess or new partial dehiscence of prosthetic valve

Question 5

What is the initial treatment for endocarditis

Answer 5

Empiric treatment: Vancomycin and gentamicin in combination for 4-6 weeks

Surgery if anatomic defects such as valve rupture, abscess, prosthetic valves, fungal, and embolic events

Question 6

What organisms are capable of causing infective endocarditis

Answer 6

1. ) Staph aureus
2. ) Strep viridans
3. ) Strep bovis - do colonoscopy too
4. ) Strep epidermis
5. ) Enterococci

Question 7

You can also give prophylactic therapy for endocarditis but it depends on certain cardiac defects and procedures. What situations would you give it

Answer 7

Cardiac defects: Prosthetic valves, unrepaired cyanotic heart disease, previous endocarditis, transplant recipients (not murmurs or pacemakers)

Procedures: Dental procedures that cause bleeding (use amoxicillin), respiratory tract surgery, skin surgery (not scoping, ob/gyn procedures, or dental fillings)