Infective endocarditis

Question 1

Infective endocarditis?

Answer 1

Infection of intracardiac endocardial structures (mainly heart valves).

Question 2

Infective endocarditis causes?

Answer 2

Streptococci, staphylococci, enterococci

Question 3

Infective endocarditis pathophysiology?

Answer 3

vegetations form when organisms deposit on the heart valves during a period of bacteraemia.

These destroy valve leaflets and invade myocardium leading to abscess cavities.

Activation of the immune system can lead to formation of immune complexes.

Question 4

Infective endocarditis risk factors?

Answer 4

Abnormal valves, prosthetic heart valves, turbulent blood flow, recent dental work.

Question 5

Infective endocarditis epidemiology?

Answer 5

16 per million in UK

Question 6

Infective endocarditis symptoms?

Answer 6

Fever with chills/sweats/rigors, malaise, arthralgia, confusion, skin lesions.

Question 7

Infective endocarditis signs?

Answer 7

Pyrexia, tachycardia, signs of anaemia, clubbing, new regurgitant murmur or muffled heart sounds, splenomegaly, vasculitic lesions (ruth spots on retina).

Question 8

Infective endocarditis investigations?

Answer 8

bloods (FBC high neutrophils, normocytic anaemia, high ESR/CRP, lots have rheumatoid factor positive),

urinalysis (microscopic haematuria, proteinuria)

blood culture,

echocardiography

Question 9

Infective endocarditis management?

Answer 9

Antibiotics for 4-6 weeks (benzylpenicillin, gentamicin), surgery for urgent valve replacement if poor antibiotic response.

Question 10

Infective endocarditis complications (6)?

Answer 10

Valve incompetence,

intracardiac fistulae or abscess,

aneurysm, heart failure,

renal failure,

glomerulonephritis,

arterial emboli