Infective Endocarditis Cases Flashcards Preview

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Flashcards in Infective Endocarditis Cases Deck (26):
1

Risk factors Infective endocarditis

abnormal valves

risk of bactermia

2

predisposing heart conditions

prosthetic valves

mitral prolapse with regurgitation or thickened leaflets

rheumatic HD

complex congenital HD

Mitral regurg, aortic stenosis, aortic regurg, ventricular spetal defect

3

predisposing procedures (5)

dental work or poor hygiene (esp w/bleeding)

skin disruption

hemodialysis

IV drugs

focal infection with typical organism

4

infective endocarditis clinical presentaion

fever

heart murmur 

chills, sweats

anorexia, alaise, weight loss

noncardiac manifestations

lab abnormalities

5

non-cardiac manifestations of infective endocarditis (5)

emboic events

splenomegaly

clubbing

petechiae

other (splinters, Oslers, Janeways, roths)

6

osler nodes

tender violaceous subq lesions in finger or toe pads (no hemmorhagic)

7

janeway lesions

nontender eryhtematous or hemorrhagic macules or papules in fingertips, palms, soles

 

(due to septic emboli)

8

roth spots

retinal lesions with hemorrhagic white central spot

9

lab abnormalities

anemia

leukocytosis

microscopic hematuria

elevated sed rate and CRP

10

prothetic valves most likely...

coag neg staph

11

acute most likely

staph a

12

elderly manifestations most likely

enterococcus

13

unusual causes 

gram neg rods

candida

14

culture negative endocarditis causes

HACEK group

nutrionally variant strep (abiotrophia)

Coxiella burnetti, 

Bartonella

Brucella

Tropheryma whipplei

15

most sensitive echo

TEE

16

Major duke criteria

Microbiologic - typical organism from 2 separate blood cxs OR organism from persistent blood cxs OR positive serology for C brunetti

Evidence of endocardial involvement - new vavlular regurg or +echo

17

Dukes minor criteria (5)

Fever

Prediposition (cardiac abrml or IV drugs)

Vascular phenom

Immuologic phenom (RF, glomeruloneph, Oslers or Roths)

microbiologic not meeting major criteria

18

Rx for penicillin susceptible strep

penicillin or ceftriaxone, 

Vanco

19

Rx for enterococci

Pen or amp with gentamicin

Vanco with gentamicin

20

Rx for staph on native valve

Nafclillin or oxacillin (+/- gentamicin)

Cefazolin (+/- gentamicin)

Vanco

21

Rx staph on prosthetic valve

Nacillin or Oxacillin AND rifampin (+/- gentamicin)

Vanco AND rifampin (+/- Gent)

22

Rx HACEK 

ceftriaxone

Amp/sulbactam

Ciprofloxacin

23

indications for surgery

CHF

prosthetic

performation or rupture

new heart block

multiple embolic events

uncontrolled infection

poorly treated wit Rx (fungi)

24

prolonged fever in IE most likely due to

S aureus

GNR

Fungi

25

mycotic aneurisms

most common with viridans sprep 

lining infected blood vessels

direct emolization/infection of wall or immune complex depos

26

dental prophylatic Rx

amoxicillin 20g PO

clindamycin

 

ampicillin 2g IV

ceftriaxone 1g IV