Endocarditis Flashcards

1
Q

What is infective endocarditis

A

Inflammation of the endocardium, usually involving the heart valves, due to infection

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2
Q

What valve is more commonly affected in infective endocarditis

A

Mitral valve

Tricuspid valve is implicated in IV drug users

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3
Q

Risk factors

A

People already with structural heart defect
IV drug abuse
Cardiac lesions
Rheumatic heart disease
Dental treatment (requires antibiotic prophylaxis)

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4
Q

Pathophysiology

Why are heart valves targeted?

A

Patients who already have a structural valve abnormality are usually affected.
Heart valves are targeted is because white blood cells cannot reach the valves due to limited blood supply of valves
Circulating bacteria adhere to the valve causing vegetations.

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5
Q

Complications

A
Heart failure
Arrhythmias
Abscess formation in the cardiac muscle
Emboli formation, may cause:
Stroke, Vision loss or spread infection to other regions of the body
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6
Q

Causative agents

A
Streptococcus viridans
Staphylococcus aureus
Staphylococcus epidermis
Diphtheroids
Microaerophilic streptococci
HACEK group: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella
(treatment depends on causative agent)
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7
Q

**Signs and symptoms

A
FROM JANE:
Fever
Roth's spots (seen on fundoscopy)
Oslers nodes (painful nodes on fingers and toes)
new Murmur

Janeway lesions (painless papules seens on the palms and plantars)
Anaemia
Nails (splinter haemorrhages)
Emboli

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8
Q

Investigations

A

Blood cultures - take 3 separate cultures from 3 peripheral sites
Bloods for anaemia
Urinalysis (microscopic haematuria)
CXR
Transoesophageal/transthoracic (ECHO for vegetations)

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9
Q

Conservative treatment

A

Maintain good oral hygiene

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10
Q

Empirical medical treatment

A

Benzylpenicillin and Gentamicin

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11
Q

Medical treatment of Streptococci

A

Benzylpenicillin (IV) and Amoxicillin

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12
Q

Medical treatment of Staphylococci

A

Flucloxacillin and Gentamicin

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13
Q

Medical treatment of Aspergillus

A

Miconazole

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14
Q

Name heart valves

A
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Aortic (Top right)
Pulmonary
Tricuspid
Mitral (Apex)
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15
Q

What classification method would you use?

A

Dukes criteria

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16
Q

Describe Dukes criteria

A

3 major criteria OR 1 major criteria and 3 minor criteria OR 5 minor criteria:

Major Criteria:
2 separate positive blood cultures
Endocardial involvement

Minor criteria: FIVE:
Fever >38 degrees
IV drug user of predisposing heart condition, and
Immunological phenomena e.g. Osler’s nodes or Roth’s spots
Vascular phenomena e.g. myocotic aneurysm ro Janeway lesions
Echocardiograph findings

17
Q

What causes the murmur heard in infective endocarditis

A

Mitral regurgitation

18
Q

Echocardiogram of infective endocarditis

A

Vegetations at heart valves

19
Q

Risk factors

A
IV drug use
Congenital heart defect
Pacemaker
Prosthetic heart valves
Elderly