Endocarditis

Question 1

What is Infective endocarditis?

Answer 1

Infection of endovascular structures of the heart leading to formation of vegetations

Often associated with destruction of the underlying cardiac tissues

Question 2

What is a vegetation?

Answer 2

thrombotic debris and microorganisms

Question 3

List 4 risk factors for IE

Answer 3

1. Previous history of infective endocarditis
2. Rheumatic valve disease
3. Prosthetic valves
4. IVDU
5. Poor dentition and dental infections

Question 4

What bacteria and what valve is commonly a/w IVDU endocarditis

Answer 4

• Staph. aureus
• Tricuspid valve

Question 5

Which valve is typically infected in IE in previously normal valves (not IVDU)

Answer 5

Mitral

Question 6

What is the most common bacterial cause of IE

Answer 6

Staphylococcus aureus

Others: Strep viridans, Staph epidermidis, Streptococcus bovis, HACEK organisms

Question 7

What are HACEK organisms?

Answer 7

Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

Question 8

Clinical presentation of IE

Answer 8

Patient with a fever and new murmur should always raise suspicion of IE

Other symptoms: anorexia, weight loss, headache, myalgia, arthalgia, night sweats, abdo pain, cough, pleuritic pain

Question 9

List 4 clinical signs of IE

Answer 9

1. Janeway lesions
2. Osler nodes
3. Splinter haemorrhages
4. Roth spots

Question 10

Compare Janeway lesions vs Osler nodes

Answer 10

Janeway - nontender macules on palms and soles

Osler - tender subcutaneous nodules on the finger pads and toes

Question 11

What are Roth Spots?

Answer 11

Exudative haemorrhagic retinal lesions with pale centres

Question 12

What ECG finding may be indicative of IE

Answer 12

PR prolongation or complete AV block - sign of aortic root abscess

Note: PR prolongation in IE is an indication for surgery

Question 13

What criteria(s) are used of IE?

Answer 13

1. Pathological criteria
2. The modified Duke criteria (clinical criteria)

Question 14

What is the Pathological criteria of IE

Answer 14

1. Microorganism on culture of a specimen from vegetation, embolism or intracardiac abscess OR
2. Pathological lesions: vegetation or intracardiac abscess; confirmed by histology

Question 15

What are the 2 ‘Major’ dukes criteria

Answer 15

1. Blood culture positive for IE
2. Echocardiogram positive for IE

Question 16

What are the 5 ‘Minor’ dukes criteria

Answer 16

1. Predisposition
2. Fever > 38.0°C
3. Vascular phenomena
4. Immunological phenomena
5. Microbiological evidence

Question 17

What defines a definite IE using the Dukes criteria?

Answer 17

1. pathological criteria positive OR
2. 2 major OR
3. 1 major + 3 minor OR
4. All 5 minor

Question 18

Treatment of IE?

Answer 18

long term IV antibiotics (~6wks)

Question 19

List 5 indications of surgery in IE

Answer 19

1. Severe valvular incompetence
2. Aortic abscess (↑PR interval)
3. Resistant infections
4. Refractory cardiac failure
5. Recurrent emboli after Abx therapy

Question 20

Is IE Prophylaxis recommended for at-risk patients undergoing interventional procedures?

Answer 20

NO

Question 21

Complications of IE

Answer 21

1. Acute valvular insufficiency causing HF
2. Neurologic eg. stroke, abscess
3. Embolic eg. infarction of kidneys, spleen or lung
4. Infection eg. osteomyelitis, septic arthritis

Question 22

What are the 4 major forms of vegetative endocarditis?

Answer 22

1. Rheumatic fever
2. IE
3. Non-bacterial thrombotic endocardits
4. Libman-Sacks endocarditis

Question 23

What is Libman-Sacks endocarditis?

Answer 23

Endocarditis of SLE