Endocarditis

Question 1

Risk factors

Answer 1

• Valve disease (esp congenital , rheumatic)
• Ventricular or Atrial Septal Defects
• IVDUs
• Surgery
nb. Dental treatment or instrumentation predisposes to endocarditis in patients that have to above risk factors

Question 2

Order of commonness - valves

Answer 2

MV>AV>TV>PV (ie, left more than right, atrio-ventricular more than with outside the heart)

Question 3

Pathogens in a native valve

Answer 3

• Viridans Streptococci
• Other streps (eg pneumonia, pyogenes)
• Enterococci
• Staphs
• Coxiella, fungal, mycobacterial (rare); atypicals (rare, culture negative

Question 4

Pathogens in a prosthetic valve

Answer 4

• Staph. aureus
• Staph. epidermidis
• Streps
• Enterococci
• Coxiella (rare); atypicals (rare, culture negative)

Question 5

Chronic Presentation

Answer 5

• Fever (chills, weight loss, anorexia, cough)
• New murmur (valve failure/CCF)
• Janeway lesions (non-tender, erythematous; microabscesses due to septic emboli)
• CVA, skin petechia, splinter haemorrhages (other embolic)
• Osler’s nodes (painful, red raised lesion due to deposition of immune complexes)
• Roth spots (vasculitis, immunological)
• Clubbing (immunological)
• Splenomegaly (immunological)

Question 6

Acute Presentation

Answer 6

• Acute fever
• CCF
• Signs of emboli
• More rapid progression of complications

Question 7

Major criteria

Answer 7

Major:
• positive blood culture with a typical organism or 3 positive blood cultures
• Evidence of endocardial damage (vegetation on echo)

Question 8

Minor criteria

Answer 8

• Predisposition to endocarditis
• Fever (>38C)
• Vasculitic or embolic phenomena
• Single positive blood culture
• Serological evidence of infection
• Uncertain echo evidence

Question 9

Diagnostic criteria (Duke’s modified)

Answer 9

2 major
OR
1 major + 3 minor
OR
5 minor

Question 10

Antibiotic therapy: Empirical (+ non-sensitive strep):

Answer 10

Benzylpenicillin + gentamicin

4-6 weeks

Question 11

Antibiotic therapy: Penicillin-sensitive strep

Answer 11

Benzylpenicillin + gentamicin
2 weeks
PO amoxicillin
2 weeks

Question 12

Antibiotic therapy: Staphs

Answer 12

IV Flucloxacillin + fucidin/rifampicin

4-6 weeks

Question 13

Antibiotic therapy: Pen-allergic or fluclox-resistant staphs

Answer 13

IV Vancomycin

Question 14

Other treatment

Answer 14

Surgical valve repair or replacement if severe embolic phenomena, heart failure or aortic root abscess

Question 15

Myocarditis presentation

Answer 15

fatigue, cardiac failure, arrhythmias

Question 16

Pericarditis presentation

Answer 16

chest pain, fever, tamponade, (often recent flu)