Endocarditis

Question 1

Endocarditis Definition

Answer 1

• inflammation of the lining of the heart
• typically involves the valves rather than the chambers, may also occur at the site of septal defects and patent ductus arteriosus
• vegetations occur on damaged valves

Question 2

Conditions associated with risk of endocarditis

Answer 2

• previous valvulitis
• congenital heart lesions
• prothestic valve
• immune-suppressed, use of sterioids
• IV drug abusers
• Dental Work

Question 3

Endocarditis 4 groups

Answer 3

• rheumatic
• atypical verrucous
• nonbacterial thrombotic
• infective

Question 4

atypical verrucous

Answer 4

• accumulation of debris in the endocardium
• associated with lupus
• 60-80% will show irregular, echogenic areas or masses located on valve surfaces
• vegetations may cause prolapse or flail valve

Question 5

Non-Bacterial thrombotic endocarditis

Answer 5

• associated with malignancies
• similar to endocarditis however vegetations are small and located at base of leaflets
• clinical information needed for diagnos

Question 6

Infective endocarditis etiology

Answer 6

• classic manifestation is vegetation
• common bacterial are streptococccus (effects damaged valves) and staphylococcus aureus (IV drug abusers, affects normal and damaged valves)
• two types acute and subacute
• aortic valve is most affected

Question 7

History

Answer 7

• fever unknown origin
• postive blood cultures
• heart failure
• underlying heart disease
• recent invasive procedure
• flu like symptoms
• chest pains

Question 8

Pathophysiology

Answer 8

• high velocity jets increase risk
• seeds on abnormal/normal valves and prosthetic valves
• organisms attach to the flow side of valves
• IV drug abusers at risk for TV vegetations

Question 9

Physical Examination

Answer 9

• new valvular regurgitation
• skin lesions (Osler nodes: small red tender areas), Janeway lesions: painless red-blue skin lesions
• embolic event
• clubbing of nails

Question 10

complications

Answer 10

• structural valve changes
• hemodynamic changes
• embolization
• neurological manifestations(stroke)
• heart failure due to sever regurg

Question 11

2-D and M-Mode

Answer 11

• vegetations appear as areas of increased echoes
• oscillations of vegetations
• leaflet disruption
• vegetation has shaggy appearence
• premature MV closure (increased LVEDP)

Question 12

Doppler

Answer 12

• presence of regurgitation
• DT < 140 msec with increased E/A ratio with severe aortic regurgitation
• high velocity flow may suggest a fistula
• valve perforation with color flow through body of a leaflet

Question 13

Treatment

Answer 13

• prevention
• antimicrobial therapy
• anticolagulation (embolic event)
• TX for heart failure
• valve devredement