Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CVS Pathologies - Summary > Infective endocarditis and rheumatic Heart disease > Flashcards

Infective endocarditis and rheumatic Heart disease Flashcards

1
Q

IE is an infection of either

A 
Inner layer of heart (endocardium)
Heart valves (native or prosthetic)
Interventricular septum (septal defect)
Chordae tendinae
Intra-cardiac devices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Non-cardiac risk factors for IE

A 
IV drug use
Indwelling medical devices
Diabetes Mellitus
AIDs
Chronic skin infections/burns
Genitourinary infections or manipulation including pregnancy, abortion and delivery
Alcoholic cirrhosis
GI lesions
Solid organ transplant
Homeless, body lice
Pneumonia, meningitis
Contact with containerised milk or infected farm animals
Dog/cat exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cardiac risk factors for IE

A 
MVP, no murmur
MVP with MR
VSD
Aortic stenosis
Rheumatic heart disease
Prosthetic heart valve
Cardiac surgery for native IE
Prior native IE 
Surgery for prosthetic IE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Early steps in bacterial colonisation

A

Colonisation of damaged epithelium

Colonisation of inflamed valve tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Venturi effect

A 
High pressure, low velocity
to 
High velocity, low pressure
to 
High pressure, low velocity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cardiac conditions at highest risk of IE

A 
Acquired valvular heart disease (stenosis, regurgitation)
Valve replacement
Structural congenital heart disease
Hypertrophic cardiomyopathy
Previous IE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mode of acquisition of IE: health care related

A
  1. Nosocomial/idiopathic (symptoms/signs >48 hours after being admitted)
  2. Non-nosocomical (sings/symptoms <48 hours after admitted and health care contact)
    - Home based nursing/IV therapy. Haemodialysis <30 days before onset
    - Acute care facility <90 days before onset
    - Resident in nursing home/long term care facility
  3. Community acquired
  4. IVDA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Types of IE

A

Acute
Subacute
Chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Symptoms/signs of IE

A 
Non-specific
- Fever (VERY COMMON)
- Fatigue
- Malasie
Recent Dental appointment
Others
- weight loss
- Headache
- muscoskeletal pain
- Altered mentation
- Murmur (VERY COMMON)
- Peripheral stigmata petechiae
- Janeway lesions
- Oslers nodes
- Splinter haemorrhages
- Clubbing
- Neurological manifestations
- Roths spots
- Splenomegaly or infarct
- Congestive Heart failure
- Vascular (immunological phenomena)
- Embolic phenomena
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Diagnostic signs of IE might be absent in

A

Elderly
After antibiotic treatment
Immunocompromised
IE involving less virulent/Atypical organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Markers of infection/inflammation

A

FBC (neutrophilia)
CRP (C-reactive protein: marker of inflammation)
ESR (erythrocyte sedimentation rate: marker of inflammation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

U+ Es (Urea and electrolytes) look for…

A

Nephritis
Infection
Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Investigations for IE

A 
Inflammation/Infection markers (FBC, CRP, ESR)
U + Es
Blood cultures (prior to antibiotics)
Urinalysis
ECG
ECHO
CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Microbiology: IE with positive blood cultures involve… (85% of all IE)

A

Streptococci
Enterococci
Staphylococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Microbiology: IE with negative blood cultures may be due to…

A

Prior antibiotic treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Microbiology: IE with negative blood cultures may be due to fastidious organisms;

A

Nutritionally variant streptococci
Fastidious gram -ve bacilli - HACEK group
Brucella
Fungi

17
Q

Microbiology: IE with negative blood cultures due to intracellular bacteria; (5% of all IE)

A

Coxiella burnetti
Bartonella
Chlamydia

18
Q

Modified Duke Criteria for diagnosis of IE

A 
MAJOR CRITERIA
- Identifying organism (Blood cultures for positive IE)
- Providing evidence of infection anywhere within the heart (Positive ECHO, New valvular regurgitation/murmur)
MINOR CRITERIA
- Focus on the endocarditis complex of clinical findings (predisposition, fever, vascular phenomena, immunological phenomena, microbiological evidence)
SO
DEFINITE:
- 2 major OR
- 1 major and 3 minor
- 5 minor
POSSIBLE:
- 1 major
- 3 minor
19
Q

Treatment for IE

A

Antibiotics (IV, start as soon as blood cultures taken)

+/- surgery

20
Q

Choice of antibiotics depend on

A 
Have they received prior antibiotics?
Native/prosthetic valves (early vs. late PVE)
Knowledge of
- local epidemiology 
- Local antibiotic resistance
- Specific culture negative pathogens
21
Q

Specific empirical treatment

A

NATIVE VALVES: 4 weeks - gentamycin + amoxicillin + vancomycin
NATIVE VALVES AND SEPSIS: gentamycin and vancomycin
PROSTHETIC VALVES: 6 weeks - Gentamycin + vancomycin + rifampicin

22
Q

Specific antibody choice for the organism depends on

A

Microorganisms isolated
Sensitivities
Resistance

23
Q

Treatment for IE due to fungi

A

Dual antifungals
Valve replacement
Other maintained long term and sometimes for life

24
Q

Complications of IE: indications for surgery

A 
Heart failure
Fistula formation
Leaflet perforation
Uncontrolled infection
Enlarging vegetation despite treatment
Abscess formation
Atrioventricular heart block
Embolism
Prosthetic valve dysfunction/dehiscence

CVS Pathologies - Summary (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions