Infective Endocarditis Flashcards Preview

Cardio - Gupta > Infective Endocarditis > Flashcards

Flashcards in Infective Endocarditis Deck (22)
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1
Q

What are some areas of the heart be affected by infective endocarditis besides the valves?

A
  • Aorta
  • Aneurysms
  • Prothetic Devices
  • Blood Vessels

Essentially anywhere in your heart that there’s foreign object or preexisting damage

2
Q

Differentiate between Acute and Subacute Infective Endocarditis.

A

Acute:
• RAPIDLY developing fever, Arthralgias, Pleuritic pain
• Previously NORMAL heart valve infected
• HIGHLY virulent organisms (Staph. aureus)
• LOTS of NECROSIS and DESTRUCTION

Subacute: 
• Gradual low-grad fever 
• Previously DEFORMED heart valves 
• LESS virulent organisms (Strep. viridans) 
• less necrosis and destruction 

Both include symptoms of night sweats, weight loss, anorexia, fatigue

3
Q

What are the gram staining characteristics of the bugs that cause infective endocarditis?

A

ALL infectious bacteria except HACEK organisms are gram +

4
Q

List the bacteria that are responsible for infective endocarditis from most to least common.

A
  1. Staphylococcus Aureus (31%)
  2. Steptococcus Viridans (17%)
  3. Enterococcus (11%)
  4. Coagulase neg. staph (e.g. Staph. Epidermidis) (11%)
  5. HACEK (2%)
  6. Fungi (2%)
  7. Culture Negative Endocarditis
5
Q

What organisms are responsible for gram - infective endocarditis?
• Culture Negative?

A

Gram - :
• HACEK - these are all COMMENSALS in the ORAL CAVITY

Culture Negative:
• Bartonella (cat scratch fever) or Coxiella (Q fever)

6
Q

What are the 3 most common organisms to cause Infective endocarditis in IV drug users?

A
  1. Staph. aureus (probably just from skin)
  2. Pseudomonas (carried by NEEDLE)
  3. Candida
7
Q

What is the most common bacteria to cause Infective Endocarditis on a prosthetic valve?
• What about colon cancer?

A

Staph. epideridis - good at creating biofilms

Colon Cancer: Streptococcus gallolyticus (aka S. bovis)

8
Q

What happens when bulky Friable lessions fall off the tricuspid or mitral valve in Infective Endocarditis?

A
  • Abscesses in Myocardium

* Emboli can cause Septic Infarcts, Septic Joints, etc.

9
Q

What are 4 major risk factors for Infective Endocarditis?

*others?

A
  • IV Drug Use - staph. aureus
  • Male Sex
  • Over 60
  • Poor Dentition - viridans most often
  • Structural Heart Disease
  • Valvular Heart Disease
  • Congenital Heart Disease
  • Prosthetic Heart Valve
  • History of IE - had it once it will likely happen again
  • Presence of IV device (Central Line)
  • Chronic Hemodialysis
  • HIV
10
Q

What are the MOST common signs of Infective endocarditis?

• Less common but HIGHLY tested?

A

MOST COMMON:
• Cardiac Murmur
• Splenomegaly
• Petechiae (extremities, Palate, or CONJUNCTIVA)
• Splinter Hemorrhages - non-blanching and red/brown in the nail bed

LESS COMMON:
• Janeway Lesions
• Osler nodes
• Roth spots

11
Q

What are…
• Janeway Lesion
• Osler nodes
• Roth Spots

A

Janeway Lesions:
• NON-tender, erythematous, Macules on the Palms and Soles

Osler nodes:
• Purple-White TENDER subcutaneous violaceous nodules mostly on the pads or fingers and toes

Roth Spots:
• Exudative, edematous Hemorrhagic Lessions on the retina with PALE centers

12
Q

Between Janeway Lesions, Osler nodes, and Roth spots, which is most associated with ACUTE infective endocarditis?
• which are immune mediated? how?

A

Janeway Lesions - non-tender, erythmatous Macules on hands and soles
• caused by neutrophil infiltrate of minor abscesses

Immune Mediated = vascular occlusion by microthrombi leading to localized immune mediated vasculitis:
• Osler Nodes
• Roth Spots

13
Q

Who should you expect Infective Endocarditis in?

• what should you do before giving antibiotics to these people?

A
  • Patients with FEVER (WITH or WITHOUT bacteremia) and CARDIAC risk factors like IV Drug use or Recent Dental Procedure
  • OBTAIN 3 POSITIVE CULTURES BEFORE giving ABX.
14
Q

T or F: ALL of the following may clue you into the fact that a patient has infective endocarditis?

A
  • Elevated Inflammatory Markers
  • Anemia
  • Positive Rheumatoid Factor
  • Hematuria
  • Proteinuria, Pyuria
15
Q

What immune phenomena are seen in Infective Endocarditis?

A
  • GLOMERULONEPHRITIS
  • Osler Nodes
  • Roth Spots
16
Q

WHAT IS THE EMPERIC THERAPY FOR IE?

A

• Vancomycin - this gives you strong gram + coverage which covers 96% of the causes of IE

17
Q

What are some common areas affected by septic emboli in IE?
• what happens to these affected areas?
• how does this differ for IV drug users?

A

INFARCTS happen in areas of embolization
• Kidneys
• Spleen

PULMONARY EMBOLI will be seen in IV drug users infected with Staph. A. because it tends to collect on the triscupid

18
Q

What are some metastatic infections that may result from IE?

A
  • Vertebral Osteomyelitis
  • Septic Arthritis
  • Psoas Abscess
19
Q

Mortality rate of IE?

A
  • 18-23% IN HOSPITAL

* 22-27% SIX MONTH MORTALITY

20
Q

what do you do after obtaining blood cultures from an IE patient?

A

Take them for an Echocardiogram and Start them on Vanc.

21
Q

Cultures come back negative for an IV drug user with suspected IE, what should you do next?

A

Think Fungal - Candida

22
Q

Someone with Hx of blood in stool comes in with IE, what should you expect is the etiologic agent?

A

Strep. Bovis/Gallolyticus