4- Endocarditis

Question 1

Endocarditis

Answer 1

Characterized by inflammation of inner lining of heart and its valve ( endocardium)

Question 2

Etiology

Answer 2

-Most often caused by bacteria entering blood stream through open wounds , abscesses, dental procedures
- damaged endocardium

Question 3

Most common agents

Answer 3

Straphylococcus aureus
Streptococcus viridians
Staphylococus epidermdids
Enterococci

Question 4

Risk factors

Answer 4

• male
• > 60yo
• acquired valve disease ( rheumatic heart disease, aortic stenosis)
• congenital heart defects
• prosthetic heart valve
• dental procedures
• cardiac implantable electronic device
• immunosupression

Question 5

Clinical features

Answer 5

• constitutional symptoms
• murmurs ( tricuspid , aortic, mitral valve regurgitation)
• heart failure ( due to valve insufficiency)
• Arrhythmias
  Extra cardiac :
• petechiae ( splinter hemorrhages)
• janeway lesions
• Osler nodes
• Roth spots
• emboli to intraabdominal organs, abscesses
• neurological manifestations
• anemia of chronic disease

Question 6

Janeway lesions

Answer 6

Small non tender erythematous macules on soles , palms

Question 7

Osler nodes

Answer 7

Painful nodules on pads of fingers, toes

Question 8

Roths spots

Answer 8

Round retinal hemorrhages withbpale center

Question 9

Diagnosis

Answer 9

• DUKE criteria
• blood cultures
• ECHO- TTE - valvular vegetation: hyperechoic masses)
• labs

Question 10

Duke criteria

Answer 10

Major, minor, pathological
>2 major , >1 major and 3 minor, or >5 minor

Question 11

Treatment

Answer 11

Broad spectrum antibiotic after culture obtained
- vancomycin + beta lactates ( ceftriaxone, cefepime)
- in prosthetic valve endocarditis add gentamicin + rifampin
- surgery: valve replacement, valve repair

Question 12

Non infective endocarditis

Answer 12

• non bacterial thrombotic endocarditis
• libman sacks endocarditis

Question 13

Non bacterial thrombotic endocarditis( def, cause, pathology, cf, diag, treat)

Answer 13

DEF: Sterile fibrin- platelet vegetations on cardiac valves
CAUSE: malignancy, hypercoagulable state
PATHOLOGY: Sterile fibrin- platelet vegetations with NO inflammation
CF: often silent, systemic emboli common
DIAG: ECHO
TREAT: anticoagulation heparin

Question 14

Libman Sacks endocarditis (def, cause, pathology, cf,diag, treat)

Answer 14

Sterile endocarditis seen in SLE , anti phospholipid antibody syndrome
CAUSE: SLE APS
PATHOLOGY: sterile vegetations with immune complexes WITH inflammation
CF: often asymptomatic, may cause mitral regurgitation and emboli
DIAG: ECHO, lupus markers
TREAT: SLE treat

Question 15

NBTE caused by

Answer 15

Malignancy
Hypercoagulable state

Question 16

NBTE pathology

Answer 16

Sterile fibrin platelet vegetations on valves
No inflammation

Question 17

NBTE clinical manifestation

Answer 17

Often silent, systemic emboli common

Question 18

NBTE diagnosis

Answer 18

Echo- sterile vegetations on valves

Question 19

Libman sack caused by

Answer 19

Autoimmune disorders- SLE, APS

Question 20

Libman sack pathology

Answer 20

Sterile vegetations with immune complexes
With inflammation

Question 21

Libman sack clinical manifestations

Answer 21

Often asymptomatic, may cause mitral regurgitation and embolism

Question 22

Libman diagnosis

Answer 22

Echo - vegetations
Lipid markers

Question 23

Treatment of Libman

Answer 23

SLE treatment

Question 24

Treatment of NBTE

Answer 24

Anticoagulantes - heparin