Foundations II (Cholley) > Infective Endocarditis > Flashcards

Infective Endocarditis Flashcards

(53 cards)

Study These Flashcards
1
Q

Define: Rheumatic fever

A

Systemic immune response after beta-hemolytic strep infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features of RF

A
  • Uncommon in US
  • Peak: 5-15 yrs
  • Self-limited carditis & valvulitis or progressive valvular deformity (MC = mitral)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

RF: Minor criteria

A

“CAFE P”

  • CRP elevated
  • Arthralgia
  • Fever
  • ESR elevated
  • Prolonged PR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

RF: Major criteria

A

“CANCER”

  • Carditis
  • Arthritis
  • Nodules
  • Chorea
  • Erythema margination
  • Rheumatic fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

RF: What is the DDx?

A
  • Rheumatoid arthritis
  • Osteomyelitis
  • Endocarditis
  • SLE
  • Lyme disease
  • Sickle cell anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

RF: Dx tests

A
  • Echo
  • ECG
  • CRP/ESR
  • CBC
  • ASO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

RF: Jones Criteria

A
  • 2 major criteria OR
  • 1 major & 2 minor OR
  • 3 minor (if recurrent)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tx of RF

A
  • Supportive care
  • Salicylates
  • Penicillin
  • Corticosteroids
  • Education
  • Prevention of recurrences
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

RF: Px

A
  • Wks to mos in children
  • Mortality 1-2%
  • 30% of children die within 10 yrs
  • Persistent carditis = poor px
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

RF: Complications

A
  • Rheumatic valve disease
  • HF
  • Arrhythmias
  • Pericarditis w/ effusion
  • Rheumatic pneumonitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

RF: Referrals

A
  • Pediatric ID
  • Pediatric rheumatologist
  • Pediatric cardio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define: Rheumatic heart disease

A

Permanent heart valve damage, subsequent to ARF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the major cause of CV disease in developing nations?

A

RHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does RHD cause?

A

Symptomatic valvular heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

RHD: Dx

A

TTE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

RHD: Tx

A
  • Restrict activity
  • Tx complications
  • Prevent IE
  • Referrals as needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define: infective endocarditis

A

Microbial infection of valvular or endocardial surface of heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

IE: Classification

A
  • Native valve endocarditis
  • Prosthetic valve endocarditis
  • Injection drug users
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Features of IE

A
  • Men > women
  • Pts over 60
  • Mortality 16-37%
  • Prosthetic valve endocarditis accounts for 10-30%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

IE: Patho

A
  • Thrombus formation on endothelial surface
  • Bacteria circulates in bloodstream, infects site
  • Bacterial proliferation –> vegetations on endothelial surface
  • Valves involved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What valve is involved in native endocarditis?

A

Mitral, followed by aortic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What valve is involved in IDUs?

Study These Flashcards
A

Tricuspid, followed by aortic

23
Q

What organism is most common in native valve endocarditis?

24
Q

What organisms are most common in prosthetic valve endocarditis?

Study These Flashcards
A
  • S. aureus

- Coagulase- negative staphylococci

25
What organisms are most common in intermediate-late endocarditis?
- Streptococci | - S. aureus
26
What organisms are most common in IDUs?
- S. aureus (most frequent) - Streptococci - Enterococci (least frequent)
27
IE: Cardiac involvement
- More likely to have right-sided IE | - Tricuspid valve involved in 30-70%
28
What are risk factors for IE?
- Age > 60 - Male - IDU - Poor dentition - Valvular disease - Congenital heart disease - Prosthetic heart valve - Hx of IE - Chronic hemodialysis - HIV
29
What are sx of IE?
- Fever - Cough - Dyspnea - Arthralgias/arthritis - Diarrhea - Abd/flank/back pain
30
IE: What is seen on PE?
- Fever - Regurgitant murmur - Peripheral lesions (petechiae, hemorrhages, osler nodes, janeway lesions, roth spots)
31
What is the DDx of IE?
Bacteremia
32
IE: Dx tests
- Blood cultures - Echo - EKG - CXR - CT-torso - Modified Duke Criteria
33
IE: Modified Duke Criteria (Definitive Dx)
- 2 major criteria OR - 1 major & 3 minor OR - 5 minor
34
IE: Modified Duke Criteria (Possible Dx)
- 1 major + 1 minor | - 3 minor
35
Features of bacterial endocarditis ("BE FIVE PM")
- Blood culture + - Endocardial involvement - Fever - Immunologic - Vascular - Echo findings - Predisposition - Microbial evidence
36
What is the overall general tx for bacterial endocarditis?
- Admit to hospital - Empiric tx covering staphylococci, streptococci, enterococci - Antimicrobial therapy (2-6 wks), monitor toxicity - Consult ID - +/- consult cardiac surgeon
37
What meds are given to those w/ native endocarditis?
Vancomycin + Ceftriaxone
38
What meds are given to those w/ prosthetic valve endocarditis?
Vancomycin + Rifampin + Gentamicin
39
What meds are used to tx viridans streptococci?
- Penicillin G IV x 4wks OR - Ceftriaxone IV x 4wks OR - 1 of the above + gentamicin IV x 2wks (Uncomplicated IE, rapid response to therapy, no underlying kidney disease)
40
What meds are used for other forms of streptococci?
- Penicillin IV x 4wks OR - Cefazolin IV x 4wks OR - Ceftriaxone IV x4wks
41
What meds are used for enterococci?
Combo therapy, PCN + gentamicin - Ampicillin IV or penicillin G IV x 4-6wks + - Gentamicin IV x 4-6wks OR ceftriaxone IV 4-6wks (CrCl < 50 or gentamicin restsitance)
42
What meds do you use for staphylococci-methicillin- SUSCEPTIBLE S. aureus?
- Nafcillin or oxacillin IV x 6wks OR | - Cefazolin IV x 6wks
43
What meds do you use for staphylococci-methicillin- RESISTANT S. aureus?
- Vancomycin IV x 6wks OR | - Daptomycin IV x 6wks
44
What meds do you add to the tx of Staphylococci – methicillin- susceptible or resistant S. aureus if pt has prosthetic valve endocarditis?
Add rifampin x 6wks | Add gentamicin x 2wks
45
What meds do you use to tx against HACEK organisms?
Ceftriaxone IV x 4wks
46
What does HACEK stand for?
- Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella
47
What is the general response to tx of endocarditis?
- Improves in 3-4 days - Repeat blood cultures - Monitor relapse
48
What does the f/u include for endocarditis?
- Baseline eval - Dental eval - Drug rehab
49
What are surgical indications of endocarditis?
- Worsening CHF - Abscess - Infection w/ fungi - Staphylococci on prosthetic valve - Failure of antibiotic therapy - 2 major emboli or 1 major embolus w/ mobile vegetation
50
When is prophylaxis of IE indicated, according to AHA?
- Prosthetic valve - Previous IE - CHD - Heart transplant w/ valvulopathy
51
What procedures require prophylaxis of IE, according to AHA?
- All dental procedures, which involve manipulation of gingival tissue or periodical region of teeth or perforation of oral mucosa - Respiratory tract procedures, that involve incision of mucosa - Procedures on infected skin, skin structure, or musculoskeletal tissue
52
What procedures DO NOT require prophylaxis?
- Ear/body piercing - Tattooing - Vaginal delivery - Hysterectomy - Routine dental work
53
What med are used for prophylaxis in dental & respiratory procedures?
Amoxicillin (most commonly)
Foundations II (Cholley)
flashcards
Decks in class (25)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions