Infective endocarditis

Question 1

What is infective endocarditis?

Answer 1

Infection of heart/valves or other endocardial lined structures within the heart (septal defects, pacemaker leads, surgical patches)

Question 2

Which groups of people are more likely to get infective endocarditis?

Answer 2

The elderly
The young IV drug abusers
The young with congenital heart disease
Those with prosthetic heart valves

Question 3

What is the pathogenesis of endocarditis?

Answer 3

Microbial adherence > bacterial adherence to platelet-fibrin nidus > vegetation (lumps of infected fibrin/clot hanging off heart valves

Question 4

What is the clinical presentation of infective endocarditis?

Answer 4

Signs of systemic infection (fever, sweats)
Embolisation - stroke, PE, bone infections, kidney dysfunction, MI
Valve dysfunction - HF, arrhythmia

Question 5

What type of test can be done to visualise IE?

Answer 5

Echocardiography (trans-oesophageal)

Question 6

What are the clinical manifestations of IE?

Answer 6

Heart murmurs
Right-sided - JVP evidence of tricuspid regurgitation
Petechiae
Splinter haemorrhages
Osler's nodes
Janeway lesions
Roth spots

Question 7

What laboratory test results can be used for diagnosis of IE?

Answer 7

Blood cultures
CRP raised
Normo-chromic normocytic anaemia frequent
Raised IG, presence of cryoglobulins, circulating immune complexes, hypocomplementaemia
Raised rheumatoid factor
Abnormal urinalysis
ECG - ischaemia or infarction, new appearance of heart block

Question 8

What treatment would be used for IE?

Answer 8

Antimicrobials based on cultures

Treatment of complications - arrhythmia, HF, heart block, embolisation

Question 9

What are the indications for surgery in IE?

Answer 9

The infection cannot be cured with antibiotics
Complications (aortic root abscess, severe valve damage)
To remove infected devices
To replace valve after infection cured
To remove large vegetations before they embolise