Flashcards in Infective Endocarditis Deck (21)
What is Subacute endocarditis and what is a common cause?
Subacute endocarditis is more common and symptoms develop over a longer period of time and it is classically caused by the viridans Streptococci.
What is Acute endocarditis and what population is typically affected?
Acute endocarditis progresses very rapidly with more severe symptoms. It was classically associated with infection caused by Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae or Neisseria gonorrhoeae and is common in intravenous (IV) drug users
What are the 4 most common organisms that cause endocarditis?
- Viradans Streptococci
- Other Strep (S. pyogenes)
- S. aureus
What patient populations with IE are most affected with Strep viridans?
Children and patients with mitral valve prolapse
What is the most common cause of IE?
What is the most common cause of IE in patients with prosthetic heart valves?
Splinter hemorrhages are linear red to brown streaks that appear under the fingernails and toenails.
Janeway lesions are small erythematous nodules observed on the palms and soles.
Osler nodes are erythematous wheal-like tender nodules 2-15 mm in diameter and are usually located on the pads of fingers and toes.
Petechiae from IE
Petechia from IE occurs in crops or batches, especially in the conjunctivae, buccal mucosa or palate, upper chest and extremities.
Round or oval retinal hemorrhages with pale centers
What are some of the cardiac signs of endocarditis?
Key signs include valvular insufficiency, a change in a pre-existing murmur or a new cardiac valvular murmur, and tachycardia
What usually precedes endocarditis?
Endocarditis is usually preceded by damage to the endothelium inside the heart and or the heart valve
How does damage to the heart or the heart valve eventually lead to endocarditis?
As a result of the tissue damage there is an accumulation of platelets and fibrin, producing a nonbacterial thrombotic endocarditis (NBTE). IE results when the lesion serves as a site for microorganisms from the blood stream to attach.
What are some symptoms that lead to suspicion of IE?
Fever with a murmur
What are the 2 major studies to confirm IE?
Blood cultures and echocardiography
What is the most sensitive study for detecting valvular vegetations?
Transesophageal echocardiography (TEE)
What is the first lab that should be done when IE is suspected?
What are the 2 major criteria for IE?
If there is good bacterial growth from more than one of blood samples (major criteria 1) and if damage to heart valves is detected by echocardiograph (major criteria 2) then IE is confirmed.
What are the 5 minor criteria for IE?
1. Predisposing heart disease or intravenous drug use
2. High body temperature
3. Evidence of vascular phenomena
4.Immunological phenomena including Glomerulonephritis, Osler nodes, Roth spots, Rheumatoid factor
5. Microbiologic evidence: defined as a single positive blood culture that does not meet the third major criterion, or serologic evidence of an active infection with an organism consistent with IE.