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Flashcards in Infective endocarditis Deck (30)
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1

What is infective endocarditis

microbial infection of valvular or endocardial surface of heart
Can be native valve, prosthetic valve, or IVDU

2

What happens during infective endocarditis

thrombus forms on the endothelial surface, bacteria infect the site and proliferate

3

What valves are involved in infective endocarditis

Native: mitral valve
Prosthetic: site of prosthesis
IDU: tricuspid (R sided), then aortic

4

What are the native IE infective organisms

S. Aureus

5

What are the prosthetic IE infective organisms

Early: S. aureus and Coag negative staph
Late: Streptococci and S. aureus

6

What are the IDU IE infective organisms

S. Aureus
Streptococci
Enterococci

7

What are risk factors for IE

>60 y/o
male
IDU
Poor dentition
HIV
chronic hemodialysis

8

What are symptoms of IE

fever, cough, dyspnea
Arthralgia's
diarrhea, abd pain, back pain

9

What will you see on physical exam for IE

New regurgitant murmur
Petechiae, splinter hemorrhage, osler node (painful), Janeway lesions, roth spots

10

What are some differentials for IE

bacteremia (cath infection, skin cardiac prosthetic infection, osteomyelitis, meningitis, PNA, sepsis)

11

What diagnostic tests are the most important for diagnosing IE

blood cultures!
Also transthoracic echo (shows vegetation, abscess, or dehiscence)
TEE (higher sensitivity)
ECG, CXR, CT torso

12

What is the Major modified duke criteria

-2 positive blood cultures
-Echo showing endocardial involvement
-New regurgitant murmur

13

What is the Minor modified duke criteria

-Predisposing condition
-Fever >38 C
-Vascular findings (aneurysm, emboli, pulm. infarct)
-Immunologic findings (osler nodes, etc.)
-Blood cultures not seeing major criteria
-Serologic evidence of infection

14

What gives you a definitive IE diagnosis based on Duke criteria

2 major OR
1 major and 3 minor OR
5 minor

(possible diagnosis if 1 major 1 minor, or 3 minor)

15

What are the diagnostic criteria for bacterial endocarditis

BE FIVE PM
B- blood culture +
E- Endocardial involvement
F- fever
I- immunologic
V- vascular
E- echo findings
P- predisposition
M- Microbiologic evidence

16

How do you treat IE

admit to hospital
empiric treatment
consult infectious disease

17

What is empiric treatment for IE

Vancomycin or Cephtriaxone
PV: Vancomycin + Gentamicin + Rifampin

18

What is treatment for Strep Viridians

Penicillin or Ceftriaxone (4 weeks)
P or C plus Gentamicin (2 weeks)
PV:
Penicillin or Ceftriaxone (6 weeks)
P or C plus Gentamicin (2 weeks)

19

What is the treatment for Other strep (not Viridans)

Penicillin
Cephazolin
Ceftriaxone

20

What is the treatment for enterococci

Penicillin or Ampicillin
PLUS Gentamicin or Ceftriaxone
(PCN + gentamicin preferred)

21

What is the treatment for MRSA

Vancomycin or Daptomycin

22

What is the treatment for S. Aureus

Naficillin
Oxacillin
Cephazolin
PV: Add Rifampin or gentamicin

23

What is the treatment for HACEK organisms

Ceftriaxone

24

How long until you should see a response with treatment for IE

3-4 days
repeat blood cultures to monitor relapse

25

What complications can occur with IE

Cardiac
Neurologic
Septic emboli
Metastatic infection
Systemic immune reaction

26

What are indications for IE surgery

worsening CHF
abscess
fungal infection
Staph on PV
Abx failure
2 major emboli

27

What is prophylactic therapy for dental and respiratory procedures

Amoxicillin

28

Who should receive prophylactic treatment

Prosthetic cardiac valve
previous IE
CHD
Heart transplant with valvuloplasty

29

What cardiac conditions do NOT need prophylaxis

MVP, RHD, AS

30

What procedures require prophylaxis

dental procedure involving gingiva (including cleaning)
incision of respiratory mucosa (tonsillectomy)
procedure on infected skin