Endocarditis

Question 1

Work up for fever with murmur, consulted for endocarditis?

Answer 1

CBC, chemistry, blood cultures, EKG, TTE

Question 2

Indications for early surgical intervention for endocarditis?

Answer 2

CHF
Acute valve dysfunction
Persistent embolization despite antibiotics
Persistent sepsis after 4-5 days abx
Paravalvular abscess
Endocarditis caused by S Aureus, fungus, gram negative bacteria
Vegetation >10mm
New conduction disturbance

Question 3

When to operate on IE patient if had cerebral embolization?

Answer 3

Wait 2-4 weeks after CVA, depending on ischemic or hemorrhagic type

Question 4

What are the common organisms for early and late prosthetic valve endocarditis?

Answer 4

Early (< 2 mo): S. Aureus, Enterococcus
Late (> 2 mo): Staph & Strep are most common

Question 5

Define the Duke Criteria:

Answer 5

1. Major
   - Blood Cx positive (2 cultures 72 hrs apart, typical organisms (Staph, Strep, HÁČEK, Fungus, Pseudomonas)
   - Evidence of Endocardial involvement (cardiac mass, abscess, dehiscence of prosthetic valve, new valvular regurgitation)
2. Minor
   - predisposing condition/IVDU
   - fever
   - vascular phenomena (emboli, Janeway)
   - immunologic phenomena (osler nodes, roth spots, rheumatoid factor, glomerulonephritis)
   - cx not in major criteira
   - echo minor criteria
   - HF
   - conduction disorder

Definitive: 2 Major, 1 Major/3 minor, 5 minor
Probably: 1 Major/1 minor, 3 minor