MR and infective endocarditis

Question 1

What are the causes of mitral regurgitation?

Answer 1

1. Rheumatic heart disease
2. IHD – associated with papillary muscle rupture
3. Valvular vegetations -> as in patients with endocarditis
4. Physiological mitral valve regurgitation due to dilated left atrium

Question 2

What are the classic peripheral signs of infective endocarditis?

Answer 2

• Fever
• Petechiae
• Splinter haemorrhages
• Osler nodes
• Janeway lesions
• Roth spots

Question 3

What are Osler nodes?

Answer 3

Tender subcutaneous nodules usually found on the distal pads of the digits

Question 4

What are Janeway lesions?

Answer 4

Non-tender maculae on the palms and soles

Question 5

What are Roth spots

Answer 5

Retinal haemorrhages with small, clear centres

- Rare and observed in only 5% of patients

Question 6

How do you diagnose infective endocarditis?

Answer 6

Modified Duke criteria 
Requires:
•	2 major criteria
•	1 major and 3 minor criteria
•	5 minor criteria

Question 7

What is the major criteria from the Modified Duke criteria ?

Answer 7

• +ve blood culture from 2 blood cultures
• +ve echocardiogram
  Mass on valve or supporting structures
  Abscess
  Partial dehiscence of prosthetic valve
  New valvular regurgitation

Question 8

What is the minor criteria from the Modified Duke criteria ?

Answer 8

• Predisposition
• Temp >38 °C
• Vascular phenomena
• Immunilogical phenomona
• Microbiological phenomena
• PCR
• Echocardiographic findings consistent with IE but do not meet major criterion