Infective Endocarditis Flashcards by Paarth Chodda

What is infective endo carditis?

Presence of vegetations on the valves due to microbial colonisations, these vegetations are friable and can cause emboli.

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List the tendancy of vegetations in endocarditis from highest to lowest?

Infective endocarditis
NOn bacterial thrombotic endocarditis
Rheumatic heart fever
Libmann sachs endocarditis

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Which condition has the highest tendency for vegetations?

Infective endocarditis

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Which condition has the lowest tendency to develop vegetations?

Libmann sachs endocarditis (SLE)

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Small vegetations are seen in which condition?

Rheumatic fever and NBTE

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Small to medium vegetations are seen in which condition?

Libmann sachs endocarditis

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Large vegetations are seen in which condition?

Infective endocarditis

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In which condition vegetations can be seen near angle of closure of valves?

Rheumatic fever and NBTE

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What is the location of vegetations in libmann sachs endocarditis?

Both upper and lower sides of valves

But mostly lower

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What is location of vegetations in infective endocarditis?

Both upper and lower sides of the valves

But mostly upper

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Verocous and warty texture is seen which conditions?

Rheumatic fever 
Libmann sachs (DORLANDs Vegetations)

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Irregular texture is seen in which condition?

Infective endocarditis

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In which all conditions do you see NBTE

Cancer
Pro-myelolytic leukaemia
High estrogenic states

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Firm vegetations are seen in which condition?

Rheumatic heart fever

Libmann sachs endocarditis

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Destruction of valves occurs in which conditions?

Libmann sachs endocarditis

Infective endocarditis

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Most friable vegetations are seen in which condition?

Infective endocarditis

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Which all conditions have sterile vegetations?

Rheumatic heart fever
NBTE
Libmann sachs

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Emboli due to vegetations occurs in which conditions?

NBTE

Infective endocarditis

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Most common valves affected in libmann sachs endocarditis are?

Tricuspid and mitral valves

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Most common affected valves in NBTE?

Mitral valve

Aortic and tricuspid are less often

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Most common affected valves in rheumatic heart fever?

Mitral and aortic valves

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Most common organism to cause infective endocarditis?

Staph aureus

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Least common organism to cause infective endocarditis?

Salmonella typhi

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List all organisms that cause infective endocarditis?

Staph aureus 
Strep. Viridans
Strep. Epidermidis
Pseudomonas
Enterococci
Salmonella typhi
HACEK GROUP

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Name organism in HACEK GROUP

``` Hemophillus Agragatibacter Cardiobacterium Ekinella Kingella ```

Name a condition that is caused by staph aureus, is highly virulent and occurs in native valve?

Acute infective endocarditis

Name a condition that occurs due to streptococci, low virulent and occurs mostly in previously affected valves?

Subacute infective endocarditis

Give etiology of infective endocarditis of IV drug abusers?

Candida and staph aureus

A patient is diagnosed with infective endocarditis and history tells you that he got prosthetic valves 8 months prior to consult. What is the organism.

Strep. Epidermidis(<12 months of prosthetic valve replacement)

A patient is diagnosed with infective endocarditis and history tells you that he got prosthetic valves 2 years prior to consult. What is the organism.

Strep Viridans(>12 months of prosthetic valve replacement)

Absence of murmurs occurs in which type of infective endocarditis?

Infective endocarditis of IV drug abuse

Most common etiology of Hospital acquired I.E?

Staph aureus

Most common etiology of community acquired I.E?

Streptococci

Most common etiology in I.E with abcess formation

Staph. Aureus

Most common etiology of prosthetic valve endocarditis?

Strep. Epidermidis

Which organism causes Austrian syndrome

Strep pneumoniae

What is triad of Austrian syndrome?

Oslers triad - meningitis - I.E - pneumonia

Name all the high risk lesions for I.E

``` MR AS AR Coarctation of aorta Tetralogy of fallot PDA VSD ```

Name the low risk lesion for I.E

ASD | Mitral valve prolapse without MR

Name the moderate risk lesion for I.E?

PS MS TS Mitral valve prolapse with MR

List the symptoms of I.E?

1. chills, malaise, anorexia, weight loss, back pain, 2. High grade fever , splenomegaly, digital infarction, emobism 3. Janeway lesions(painless) 4. Roth spots 5. Oslers nodes(painful) 6. Murmurs

What are the lab test results for I.E?

``` Anemia Leukocytosis Rheumatoid factors + 2/3 cultures positive (all done 1 hour apart) ESR & CRP elevated ```

Which diagnostic criteria is used for I.E?

Dukes criteria

List major criterias of Duke’s criteria?

2/3 cultures positive | Involvement of valvular lesions

List minor criteria of Duke’s

Fever Predisposing cardiac lesions Positive blood culture (but not meeting major criteria) VASCULAR phenomenon (janeway lesion, pulmonary infarct,mycotic aneurysm, intracranial haemorrhage) IMMUNOLOGICAL henomenon( oslers nodes,roth spots,glomerulonephritis)

Confirmed diagnosis of I.E if

2 major 1 major + 3 minor 5 minor

What are valvular complications of I.E

Valvular insufficiency Valvular stenosis Valvular perforations

What are the mural complications of IE

Abcess formation | Pericarditis(due to abcess spread)

What is complications associated with aorta in IE?

Perforations of aorta

In case of IE in patient with prosthetic valves. Which procedure is necessary?

Tracheoesophageal cardiography

Pencillin susceptible streptococci treatment?

1. Penicillin G/ ceftriaxone / vancomycin-for 4 weeks | 2. Gentamicin for 2 weeks

Relatively Penicillin resistant streptococci treatment?

1. Penicillin G/ ceftriaxone for 4 weeks. 2. Gentamicin for 2 weeks. 3. vancomycin for 4 weeks.

Organism Moderate resistant to penicillin treatment ?

1. Penicillin G/ceftriaxone for 6 weeks 2. Gentamicin for 6 weeks 3. Vancomycin for 4 weeks

Treatment for enterococci

Penicillin/ampicillin/vancomycin Gentamicin (BOTH FOR 4 TO 6 WEEKS)

Treatment for MSSA(methicillin susceptible staph aureus)

1. Nafcillin/oxacillin/flucoxacillin | 2. Cefazolin/vancomycin

Treatment for MRSA infecting native valves

Vancomycin

Treatment for MRSA infecting prosthetic valves

Vancomycin Gentamicin Rifampicin

Treatment for MSSA infecting Prosthetic valves?

Nifacilin/oxacillin/flucoxacillin(6-8 weeks) | Gentamycin(2 weeks)

HACEK group treatment?

Ceftriaxone 2g/day IV Or give ampicillin or sublactam All for 4 weeks

Doxycycline can be given for which organism

Coxella burmetti and bartonella species.

For batonella species what treatment is given

Doxycycline/ampicillin/ceftriaxone | Gentamicin

For coxiella burmetti what is the treatment?

Doxycycline

Indication for surgical treatment in IE?

``` Aortic valve endocarditis Prosthetic valve endocarditis Fungal endocarditis Presence of valve ring abscess Failiure of medical treatment Very large vegetations that can cause emboli ```

What is the etiology of fungal endocarditis

Candida and aspergillosis

Medical and surgical treatment for fungal endocarditis?

Medical- Amphotericin B & Flucytosine | Surgical - Radical surgical debridement

Most commonly affect population with fungal endocarditis

People with prosthetic valves or immune compromised

A Patient with prosthetic valve and infective endocarditis is undergoing another surgery. What prophylaxis drug will you suggest.

Amoxicillin Clindamycin/cefalexin/clarithromycin (if allergic to amoxicillin) Gentamycin(if gram -ve organism)

Cardiac high ridk lesions where amoxicillin prophylaxis is requir

``` Prosthetic valves endocarditis Prior bacterial endocarditis Cyanotic congenital heart disease PDA Coarctation of aorta ```

Cardiac moderate risk lesions where amoxicillin prophylaxis is required?

``` Hypertrophic cardiomyopathy MR AR Bicuspid aortic valve VSD Mitral valve prolapse ```

Low risk cardiac lesions where amoxicillin prophylaxis is required

Presence of cardiac pacemaker, fibrillators CABG ASD Physiological and functional murmurs

Infective Endocarditis Flashcards

(70 cards)