Flashcards in Infective Heart Disease and HEart Failure Deck (22)
What is teh most common s for infectious endocarditis?
staph epidermidis(coag neg)
What are properties of successful IE pathogens?
survive antimicrobial components of serum
able to adhere to endocardium
What allows viridan strep to bind endocardium?
dextran(exopolysaccharide) and adhesins that mediate attachment to platelets and fibrin
What allows staph aureus to bind endocardium?
s. aureus, fibrinogen-binding adhesins
what is the life in a vegetation for infectious endocarditis?
-heterogenous matrix of deposited stuff
protection from immune cells
bacteria can achieve high density
What type of antibiotic therapy do you need for infectious herat disease
parental admin for sustained activity
long term tx
What is the mechanism of action of vancomycin?
binds to D-ala-Dala at the petpide size of peptidoglycan
What does daptomycin mechanism of action and spectrum?
bacteriaicidal, narrow spectrum
bind and disrupt cyctoplsmic membrane, possibly via loss of membrane potential
What does rifampin target adn mechanism of action?
binds to and inhibits RNA pol
bacteriacidal, gram pos
Gentamicin works well in combination with what?
30S inhibitor that works well with cell wall disrupters.
What are the predisposing procedures for endocarditis?
dental work or poor hygene, skin dsirupsttion
focal infection with typical organism
What is the clinical presentation of endocarditis?
acute or subacute onset
fever large majority
chills sweats 40-75%
anorexia malaise weight loss 25-50%
What are noncardiac manifestations of endocarditis?
What are the lab abnormalities associated with endocarditis?
elevated sed rate and c reactive protein
What are the most common causes of endocarditis in different pts pop?
strep and staph aureus for acute
coag neg staph for prosthetic
enterococcus in elderly
What are the culture negative endocarditises?
Diagnosis of endocardtisi is made how?
two major, one major plus 3 minor of Duke criteria
What are the major indications in the duke criteiria?
typical organism from 2 sep blood cx
organism from persistently pos blood cx
posserology for c. burnetti
evidence of endocardial involvment
-new valvurla regurgitation
What are the minor indications of the duke criteria?
predisposition to infective endocarditis
microbologic not meeting major criteria
What are the indications for surgery in endocarditis?
prosthetic valve endocarditis
valve perforation or rupture
uncontrolled infection on appropiate Rx
uncertain pathogen poorly tx (fungi)
What are compications of endocarditis?
cardiac -CHF,, Heart block, vlave failure, absecess or fistur
neurologic, embolic stroke, myotic aneurysm, menigintis
septic emboli abscesses