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CV PATH...Hemodynamic Disorders > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

1
Q

Epidemiology

A

uncommon
adults
slightly more in males

usually on the valves more so than other areas of endocardium

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2
Q

Characteristics

A

causes “vegetations”

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3
Q

vegetations

A

friable masses of blood clot and infecting organisms

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4
Q

friable

A

the ability of a solid substance to be reduced to smaller pieces with little effort.

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5
Q

pathogenesis

A
  1. valvular endothelial injury
  2. platelet and fibrin deposition
  3. microbial seeding
  4. microbial multiplication
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6
Q

prognosis

A

100% fatal if undiagnosed and untreated

20% fatal if diagnosed and treated appropriately (IV antibiotics and/or surgery)

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7
Q

3 classification systems

A
  1. clinical course
  2. host substrate
  3. specific infecting organism
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8
Q

classification via clinical course

A

acute bacterial endocarditis (ABE) vs.

subacute bacterial endocarditis (SBE)

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9
Q

ABE

A

usually fulminant and due to highly virulent organisms (i.e. S. aureus)

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10
Q

SBE

A

insidious onset over weeks and due to less virulent organisms (viridans streptococci)

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11
Q

classification via host substrate

A

native valve endocarditis (NVE) versus
Prosthetic valve endocarditis (PVE) versus
edocarditis in IVDU

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12
Q

PVE

A

commonly due to coag negative S. epidermis, which is rare in NVE

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13
Q

Endocarditis in IVDU

A

commonly acute and commonly on tricuspid valve

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14
Q

classification via specific infecting organism

A

i.e. pseudomonas aeruginosa endocarditis

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15
Q

Anatomic sites of IE

A

Left-sided valves….75%
Right-sided valves…15%
Both…5%
Other…..5%

Mitral valve alone....35%-------|
Aortic valve alone...20%-------|-->75%
Mitral and aortic...20%---------|
Tricuspid...14%------|
Pulmonic....1%------|-->15%
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16
Q

What percentage of pts w/ IE have predisposing heart disease?

A

70%

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17
Q

What are some predisposing heart diseases?

A 
MVP
congenital disease
prosthetic valve
degenerative disease
rheumatic disease
previous endocarditis
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18
Q

portals of entry for organisms causing IE

A 
central venous catheterization
endoscopy
shaving
dental procedures
gingivitis
chewing
brushing teeth
surgery
bladder catheterization
IVDU
etc.
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19
Q

correlation b/w ability of bug to cause IE and its ability to…

A

adhere to blood clot

20
Q

dextran

A

facilitates adherence of some streptococci to blood cot

(cell wall component)

esp. streptococcus mutans… a viridans that causes dental caries by same MOA

21
Q

Most common etiological agents of IE in tertiary care hospitals

A
  1. Staphylococci in 42%
    —-S. aureus in 32%
    —-CoagNS in 10%
  2. Streptococci 40%
    —-Viridans group (oral flora) 18%
    —-enterococci 11%
    —-S. bovis (assoc. w/ colon cancer) in 6%
    —-others 5%
    (In RURAL settings, viridans=more common cause than S. aureus!)
  3. HACEK group bacteria 4%
  4. other gram-negative aerobes 3%
  5. fungi (esp. Candida) 2%

NEGATVE BLOOD CULTURES or multiple causative organisms…9%

22
Q

HACEK

A

fastidious slow-growing oral flora)

23
Q

gross pathology

A

–large (up to 3cm), friable vegetations
(some combo of tan, gray, red, or brown)
–range of # of vegetation (1 to many)
–vegetations usually located on line of valve closure (the atrial side of AV valves, or ventricular side of semilunar valves)

24
Q

the larger the vegetation…

A

the more likely it is to be infected

25
Q

IE consequences

A 
destructive of tissue
may cause perforation of valve
adjacent abscess
fibrotic scarring
calcification
26
Q

microscopic pathology of the vegetations

A

fibrin
platelets
masses of organisms
sometimes necrois and neutrophils

later, lymphocytes, macrophages, fibroblasts may infiltrate and fibrosis may occur

27
Q

Common symptoms

A

**fever
chills
weakness
dyspnea

28
Q

Less common symptoms

A 
cough
sweats
anorexia
weight loss
malaise
skin lesions
nausea/vomiting
stroke
headache
myalgia/arrthralgia
edema
chest pain
abdominal pain
delirium/coma
back pain
hemptysis
29
Q

Common physical signs

A

fever
heart murmur
splenomegaly
petechiae

30
Q

uncommon physical signs

A 
Osler nodes
subungual splinter hemorrhages
changing heart murmur
Janeway lesions
new heart murmur
Roth spots
31
Q

Osler nodes

A

pea-sized tender finger/toe nodules

32
Q

Janeway lesions

A

small palm/sole hemorrhages

33
Q

Roth spots

A

white dots w/ surrounding hemorrhage in retina

34
Q

Uncommon signs vs common signs

A

the uncommon signs are more specific

35
Q

Common lab findings

A

elevated ESR
circulating immune complexes
anemia
proteinuria

36
Q

Less common lab findings

A 
rheumatoid factor
hematuria
leukocytosis
hypergammaglobulinemia
elevated creatinine
leukopenia
thrombocytopenia
37
Q

Rheumatoid factor

A

anti-IgG antibodies

38
Q

characteristic of endocarditis

A

continuous low-grade bacteremia

39
Q

Blood cultures

A

Some types need special cultures for fastidious organisms…hod cultures longer

**critical for specific diagnosis

may be negative if already received antibiotics

40
Q

What can show vegetations in 60% of cases?

A

transthoracic echocardiography

41
Q

what has greater than 90% sensitivity?

A

transesophageal echocardiography

42
Q

does the absence of vegetations on echocardiogram exclude diagnosis of endocarditis?

A

No!

43
Q

Duke Criteria for infective endocarditis

A

requires 2 major, OR
1 major and 3 minor, OR
5 minor criteria fulfilled for a diagnosis

44
Q

Complications

A 
HF
septic emboli
--kidneys
--heart
--spleen
--brain
45
Q

More uncommon complications

A

Myocardial abscess
GN
“mycotic aneurysm”
pericarditis

46
Q

If suspect IE…

A

don’t wait for echo…
get the blood cultures, put “suspect endocarditis” on requisition, and
start antibiotic therapy!

CV PATH...Hemodynamic Disorders (18 decks)

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