L8: Infective Endocarditis Flashcards
(86 cards)
1
Q
IE refers to …….
A
2
Q
Etiology of Infective Endocarditis
A
3
Q
Etiology of Infective Endocarditis
- Pathogens
A
4
Q
Etiology of Infective Endocarditis
- most common bacteria causing IE
A
Streptococcus Viridians
5
Q
Etiology of Infective Endocarditis
- most common fungus causing IE
A
Candida albicans
6
Q
The most common microbiologic etiologic agents causing IE change over time.
A
…
7
Q
Etiology of Infective Endocarditis
- RF
A
8
Q
Pathogenesis of Infective Endocarditis
A
9
Q
Pathogenesis of Infective Endocarditis
- endothelial Damage
A
10
Q
Almost all patients with congenital heart defects are complicated by IE except …..
- Due to low pressure gradient between both atria so no turbulent flow and no endocardial damage
A
- secundum ASD
11
Q
Pathology in Infective Endocarditis
A
12
Q
CP of Infective Endocarditis
A
- Hx
- Symptoms
- Signs
13
Q
CP of Infective Endocarditis
- Hx
A
14
Q
CP of Infective Endocarditis
- Symptoms
A
15
Q
CP of Infective Endocarditis
- Signs
A
16
Q
Signs of Infective Endocarditis
- Manifestations of the disease are due …..
A
Manifestations of the disease are due to:
- Toxemia
- Cardiac damage
- Embolization
- Immune complexes
17
Q
Signs of Infective Endocarditis
- Cardiac
A
Heart murmur is almost always present (85 - 90 %)
- Development of a new heart murmur or change in a pre-existing one
18
Q
Signs of Infective Endocarditis
- Spleen
A
Splenomegaly is common (70%)
19
Q
Signs of Infective Endocarditis
- Embolic & Immunologic
Rare in Chidren
A
20
Q
Embolic & Immunologic Signs of Infective Endocarditis
- Skin
A
21
Q
Embolic & Immunologic Signs of Infective Endocarditis
- Most Common
A
- Petechiae on the skin, mm, or conjunctivae
22
Q
Embolic & Immunologic Signs of Infective Endocarditis
- Petechiae
A
- Petechiae on the skin, mm, or conjunctivae
23
Q
Embolic & Immunologic Signs of Infective Endocarditis
- Osler’s Nodes
A
Painful, pea-size pink nodes at the Pulps of fingers or toes
24
Q
Embolic & Immunologic Signs of Infective Endocarditis
- janeway Lesions
A
small, painless, hemorrhagic areas on the palms or soles
25
Embolic & Immunologic Signs of **Infective Endocarditis**
- Splinter Hemorrhage
linear hemorrhagic streaks beneath the nails
26
Embolic & Immunologic Signs of **Infective Endocarditis**
- Lung & Spleen
Pulmonary & Splenic emboli
27
Embolic & Immunologic Signs of **Infective Endocarditis**
- CNS
CNS emboli → Seizures and hemiparesis occur in 20% of cases.
28
Embolic & Immunologic Signs of **Infective Endocarditis**
- Kidney
Glomerulonephritis (Hematuria) and renal failure
29
Embolic & Immunologic Signs of **Infective Endocarditis**
- Eye
Roth's spots (oval, retinal hemorrhages with pale centers located near optic disc)
- Occur in < 5% of patients.
30
Embolic & Immunologic Signs of **Infective Endocarditis**
- toxemia
- Fever associated with systemic symptoms
- Clubbing fingers in absence of cyanosis
31
INvx for **Infective Endocarditis**
32
INvx for **Infective Endocarditis**
- Labs
33
Blood Culture in **Infective Endocarditis**
34
Blood Culture in **Infective Endocarditis**
- Indications
35
Blood Culture in **Infective Endocarditis**
- Technique
36
Blood Culture in **Infective Endocarditis**
- Results
37
Blood Culture in **Infective Endocarditis**
- Special Situations
38
Labs in **Infective Endocarditis**
- CBC
39
Labs in **Infective Endocarditis**
- APR
Increased ESR unless there is polycythemia
40
Labs in **Infective Endocarditis**
- Urinalysis
Microscopic hematuria (in 30% of patients)
41
Rads in **Infective Endocarditis**
42
Rads in **Infective Endocarditis**
- MSCT
May be used in recent embolic events and paravalvular lesions
43
Rads in **Infective Endocarditis**
- MRI
For detection of cerebral lesion
44
Rads in **Infective Endocarditis**
- ECHO
45
ECHO in **Infective Endocarditis**
46
ECHO in **Infective Endocarditis**
- Types
47
ECHO in **Infective Endocarditis**
- Uses
Detects the site and extent of valvular damage
48
ECHO in **Infective Endocarditis**
- Findings
49
ECHO in **Infective Endocarditis**
- false -ve
- vegetations are small
- Have already embolized
50
ECHO in **Infective Endocarditis**
- Notes
- Echo evidence of vegetation may persist for up to years.
- The absence of vegetation on echo does not in itself rule out lE.
51
Dx of **Infective Endocarditis**
52
Dx of **Infective Endocarditis**
- Modified Duke Criteria
53
Modified Duke Criteria
- Major Clinical Criteria
54
Major Clinical Criteria
- Blood Culture
55
Major Clinical Criteria
- Imaging
56
Modified Duke Criteria
- Minor Clinical Criteria
57
Minor Clinical Criteria
- Predisposition
predisposing heart condition or injection drug users.
58
Minor Clinical Criteria
- Fever
temperature > 38° C
59
Minor Clinical Criteria
- Vascular Phenomena
- Major arterial emboli
- septic pulmonary infarct
- Janeway lesions
- Mycotic aneurysm
- Conjunctival
- Intra-cerebral hemorrhage
60
Minor Clinical Criteria
- Immunologic Phenomena
As mentioned Before
61
Minor Clinical Criteria
- Microbiologic Evidence
Positive blood culture but doesn't meet a major criterion
62
- Modified Duke Criteria
Pathological Criteria
63
Pathological Criteria
- Microorganisms
64
Pathological Criteria
- Pathological Lesions
- vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis
65
Diagnostic MDC
66
Diagnostic MDC
- Definite
67
Diagnostic MDC
- Possible
68
Diagnostic MDC
- Rejected
69
Management of **Infective Endocarditis**
- Blood Culture
- Medical
- Surgical
70
Management of **Infective Endocarditis**
- Blood Culture
Previosly Mentioned
71
Management of **Infective Endocarditis**
- Initial empiric Therapy
72
Initial Empiric Therapy in Management of **Infective Endocarditis**
- Community Acquired
73
Initial Empiric Therapy in Management of **Infective Endocarditis**
- Nosocomial
74
Management of **Infective Endocarditis**
- Specific Antibiotics
75
Specific Antibiotics in Management of **Infective Endocarditis**
- Streptococci
76
Specific Antibiotics in Management of **Infective Endocarditis**
- Staphylococci
77
Management of **Infective Endocarditis**
- Surgery
78
Management of **Infective Endocarditis**
- Indication of Surgery
79
Prevention of **Infective Endocarditis**
80
Prevention of **Infective Endocarditis**
- Conditions Requiring Prophylaxis
81
Conditions Requiring Prophylaxis in **Infective Endocarditis**
- CHD
82
Procedures Requiring Prophylaxis in **Infective Endocarditis**
83
Procedures Requiring Prophylaxis in **Infective Endocarditis**
- Dental procedures
84
Procedures Requiring Prophylaxis in **Infective Endocarditis**
- Respiratory Tract Procedures
85
Procedures Requiring Prophylaxis in **Infective Endocarditis**
- GI & GU Procedures
86
Procedures Requiring Prophylaxis in **Infective Endocarditis**
- Skin / MSK Tissue
