Infective endocarditis Flashcards Preview

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Flashcards in Infective endocarditis Deck (10):
1

Define: Infective Endocarditis

Infection of innermost layer of heart, usually involving valves.

2

History for Infective endocarditis

- Fever (often PUO)
- Non-specifics: weight loss, anorexia, malaise, fatigue...
- Acute Sx: SOB, chest tightness, emboli
- Dental Hx
- PMHx: RF, congenital heart disease, valve replacement, long term lines, bacteraemias, GI issues
- IVDU

3

Examination findings in Infective endocarditis

- Changing murmur
- Clubbing, splinter haemorrhages, Osler's nodes, Janeway lesions, Roth spots
- Spleen
- Haematuria

4

Investigations for Infective endocarditis

- FBC (low Hb),
- CRP to monitor therapy
- ESR
- 3 blood cultures before Abx
- sereology if cultures -ve
- CXR
- echo

5

Subacute bacterial endocarditis -
Course and agents

Low virulence Strep, often viridans.
Mild-moderate illness over weeks / months.

6

Acute bacterial endocarditis -
Course and agents

Fulminant illness in days.
Staph aureus,
or coagulase -ve Staph in prosthetic valves.

7

Causes of Culture negative Infective endocarditis

Usually post Abx.
HACEK: Haemophilus parainfluenzae, Aggregatibacter/Actinobacillus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae.
Or Aspergillus, Brucella, Coxiella, Chlamydia, Mycoplasma.

8

Emprirical Tx for Infective endocarditis

Prosthetic valve: Vanc, gent, rifampicin;
Native valve acute: Fluclox;
Native valve indolent: Pen + gent.

9

Indications for surgery in Infective endocarditis

- Serious embolism
- Uncontrolled infection
- Significant valve dysfunction
- Lack of response to Abx
- Local pus (eg. perivalvular abscess)
- Congestive heart failure
- Due to prosthetic valve

10

Tx for known organisms in Infective Endocarditis

Strep viridans: Benpen + gent;
MSSA: Fluclox;
MRSA: Vanc + gent;
Enterococci: Ampicillin + gent.