Infective Endocarditis & Rheumatic Heart Disease

Question 1

what is endocarditis?

Answer 1

infection of inner layer of the heart

Question 2

has mortality of endocarditis decreasing?

Answer 2

no stayed the same :(

Question 3

for what reasons is endocarditis not a uniform disease?

Answer 3

various presentations

possibly dependent on underlying cardiac disease

microorganism involved

presence / absence of complications

underlying patient characteristics

Question 4

what professions are involved for patients with endocarditis?

Answer 4

primary care physicians / acute medicine
cardiologists
surgeons
microbiologists
infectious disease
(neurologists, neurosurgeons, radiologists, pathologists)

Question 5

what gender is more likely to get endocarditis and which gender has the worse prognosis?

Answer 5

2:1 males have it but womens have worse prognosis

Question 6

what are non-cardiac risk factors?

Answer 6

injection drug use
diabetes
chronic skin infections
alcohol cirrhosis
gastrointestinal lesions
pneumonia

Question 7

what are cardiac risk factors?

Answer 7

MVP(mitral valve prolapse)
VSD (Ventricular Septal Defect)
aortic stenosis
rheumatic heart disease
prothetic heart valcve

Question 8

what are the classifications of infective endocarditis?

Answer 8

acute
subacute
chronic

Question 9

what are non-specific symptoms?

Answer 9

fever
fatigue
malaise

Question 10

what are signs of endocarditis?

Answer 10

congestive cardiac failure

immune complex deposisiton:splinter haemorrhages, vasculitic rash, roth spots, olsers nodes, janeway lesion

embolic phenomena

Question 11

what is a vasculitic rash?

Answer 11

diffuse
non-blanching
petechial
purpuric

Question 12

what are roth spots?

Answer 12

retinal haemorrhages
white/pale centre
coagulated fibrosis

Question 13

what are olsers nodes

Answer 13

deep, red spots
painful
raised
finger pulps

Question 14

what are janeway lesions?

Answer 14

flat, macular
echymotic
palms / soles

non-tender

Question 15

what would give you a high index of suspicion?

Answer 15

fever
new murmur
pyrexia of unknown origin
known IE causative organism
prosthetic material
PPM
ICD
prosthetic valve
baffle / conduit
previous IE
congenital heart disease
new conduction disorder
immunocompromised / IVDA

Question 16

who might the signs be abscent in?

Answer 16

elderly

after antibiotic treatment

immunocompromised

IE involving less virulent / atypical organisms

Question 17

how would you investigate endocarditis?

Answer 17

use markers of infection/inflammation:
FBC
neutrophilia
CRP
ESR

blood cultures* prior to starting antibiotics

urinalysis

ECG

chest xray- heart failure, pulmonary abscesses

echocardiogram-TOE

Question 18

what is the mircobiology involved in IE

Answer 18

streptococci
enterococci
staphylococcus

Question 19

what are the different types of strept

Answer 19

oral viridans
S.milleri, S.angionosus group
group D strep

Question 20

what are the three different types of enterococci?

Answer 20

E. faecalis
E. faecium
E. durans

Question 21

what are the types of staphylococcus?

Answer 21

s.aureus

coagulase negative staph

Question 22

whats the modified duke criteria?

Answer 22

identifying organism

providing evidence of infection anywhere within the heart

Question 23

whats the treatment of endocarditis

Answer 23

antibiotics started as soon as all blood cultures taken. intravenous

+/- surgery

Question 24

what does the choice of antibiotics depend on?

Answer 24

receieved prior antibiotics

native or prosthetic valve

Question 25

what treatment would you give for native valves- 4 weeks

Answer 25

IV Gentamicin + IV Amoxycillin

Question 26

what treatment would you give for native valves and sepsis

Answer 26

IV Vancomycin (as per protocol) penicillin allergic severe sepsis MRSA

Question 27

what treatment would you give for prosthetics - 6 weeks

Answer 27

Rifampicin (300-600mg IV/PO 12 hourly) | prosthetic valves

Question 28

what are complications of endocarditis?

Answer 28

heart failure fistula formation leaflet perforation uncontrolled infection abscess formation atrioventricular heart block embolism prosthetic valve dysfunction /dehiscence

Question 29

what are indications for surgery?

Answer 29

heart failure most frequent + severe complication refractory pulmonary oedema fistula formation leaflet perforation leaflet obstruction prevention of embolism

Question 30

what are the cardiac conditions most at risk of IE?

Answer 30

acquired valvular heart disease stenosis regurgitation valve replacement structural congenital heart disease hypertrophic cardiomyopathy previous IE

Question 31

when do you offer prophylaxis?

Answer 31

an antibiotic that covers organisms that cause IE if a person at risk of IE is receiving antimicrobial therapy due to undergoing a GI or GU procedure at a site where there is suspected infection

Question 32

when do you not offer prophylaxis?

Answer 32

dental procedures ``` non-dental procedures: upper/lower GI tract genitourinary tract urological gynaecological obstetric childbirth upper/lower respiratory tract ENT throat procedures bronchoscopy ```

Question 33

what risk does body piercing and tatooing have?

Answer 33

infective endocarditis

Question 34

what are the echocardiogram findings?

Answer 34

``` periannular complications severe left sided valv regurgitation low left ventricular ejection fraction pulmonary hypertension large vegetations ```

Question 35

what are tge organisms involved?

Answer 35

s.aureus fungi gram negative bacilli