Endocarditis

Question 0

Endocarditis from staph aureus versus strep viridans?

Answer 0

Acute versus subacute endocarditis

Question 1

Suspect patient with tricuspid endocarditis – next steps?

Answer 1

Obtain serial blood cultures and institute empiric broad-spectrum antibiotics

Question 2

Acute verses subacute endocarditis?

Answer 2

Acute – high fever, Valvular regurgitation, emboli

Subacute –

1. Constitutional symptoms (anorexia, weight loss, night sweats)
2. Complex deposition
3. septic vasculitis (petechia, splenomegaly, glomerulonephritis)

Question 3

Stereotypical symptoms of endocarditis?

Answer 3

FROM JANE
Fevers
Roth spots
Osler's nodes
Murmur
Janeway lesions
Anemia
Nailbed hemorrhages
Emboli

Question 4

Unique complication of right-sided endocarditis?

Answer 4

Pulmonary emboli
Pleuritic chest pain
Purulent sputum
Hemoptysis

CXR: peripheral nodular lesions with cavitation

Question 5

Criteria for obtaining blood cultures?

Answer 5

Acute – three blood cultures over 2 to 3 hour period prior to initiating antibiotics

Subacute – three blood cultures over 24 hour period

Question 6

Endocarditis from intravascular catheter?

Answer 6

Staph aureus/Candida

Question 7

Endocarditis in pt with prosthetic valves?

Answer 7

Coagulase negative staph (epidermidis)

Question 8

Endocarditis after UTI? Treatment?

Answer 8

Enterococci

Ampicillin an gentamicin

Question 9

Endocarditis in neonates?

Answer 9

Coagulase negative staph

Question 10

Endocarditis in patient with G.I. problem?

Answer 10

Strep bovis

Question 11

Duke Major criteria?

Answer 11

1. Two positive blood cultures

2. Evidence of endocardial involvement (echo evidence, new valvular regurgitation, oscillating intracardiac mass)

Question 12

Duke minor criteria?

Answer 12

1. Predisposing Valvular lesion
2. IV drug use
3. Fever over 38
4. Vascular signs (septic pulmonary emboli, mycotic aneurysm, Janeway lesions)
5. Immunologic phenomenon (glomerulonephritis, Osler’s nodes, Roth spots, RF)

FIVIV

Question 13

How to evaluate endocarditis based on Duke criteria?

Answer 13

1. Two major criteria
2. One major and three minor criteria
3. Five minor criteria

Question 14

Life-threatening complication endocarditis?

Answer 14

Congestive heart failure as a consequence of vascular damage

Question 15

Other cardiac complications of endocarditis?

Answer 15

1. Abscesses
2. Conduction disturbances
3. Arterial emboli causing splenic and renal infarctions
4. Emboli causing MI or stroke
5. Mycotic aneurysms (rupture can lead to hemorrhage)

Question 16

Treatment for streptococcus endocarditis?

For staph aureus endocarditis?

For HACEK?

For fungal?

Answer 16

Ceftriaxone

Nafcillin/Vanc with gentamicin ( vancomycin if MRSA or CoNS)

Ceftriaxone

Amphotericin and valve replacement

Question 17

Need surgical management of endocarditis if?

Answer 17

1. Positive cultures after seven days of therapy
2. Fungal endocarditis
3. Prosthetic valves
4. Myocardial abscess formation
5. One serious embolic episode or >10 mm vegetation
6. AV block
7. CHF/ruptured cordae tendonae

Question 18

Drug of choice for prophylaxis?

Answer 18

Amoxicillin

If allergic use clindamycin

Question 19

Most common causes of culture negative endocarditis?

Answer 19

Coxiella

Batonella

Question 20

Who gets endocarditis ppx?

Answer 20

Pts with both

1. Cardiac defect (prosthetic valve, previous endocarditis, heart transplant, unrelated or cyanotic heart disease)
2. Upcoming dental work or respiratory surgery

MVP not an indication!!

Question 21

Most common causes of culture negative endocarditis?

Answer 21

Coxiella

Batonella

Question 22

Who gets endocarditis ppx?

Answer 22

Pts with both

1. Cardiac defect (prosthetic valve, previous endocarditis, heart transplant, unrelated or cyanotic heart disease)
2. Upcoming dental work or respiratory surgery

MVP not an indication!!