endocarditis

Question 1

1. The intracardiac effects

2. Systemic signs and symptoms through 2 main mechanisms: sterile and infected emboli and immunological processes.

Answer 1

1. • vegetations; severe valve insufficiency
     - congestive heart failure - myocardial abscesses. 2.-sterile and infected emboli
   • immunological processes.

Question 2

Etiopathology endocarditis- classification:

Answer 2

Native valve endocarditis,
Prosthetic valve (early and late) endocarditis,
Endocarditis related to intravenous drug use (tricupsid valve),
Endocarditis with culture-negative results (vasculitis- colagenosis; fungal inf.)

Question 3

Subacute IE (SIE):

Answer 3

Cardiac level: change of the character of the pre-existing murmur/ new murmur
(aortic regurgitation)

Systemic:

• embolizations of the vegetations
• immunologic reactions- tissue injury with deposition of the antigen-antibody complex

Question 4

Clinical manifestations – S IE

Answer 4

• General symptoms: fever, fatigability, weight loss, sweats, pallor “cafe au lait”
• stroke or transient ischemic attack
• glomerulonephritis (due to immune complex deposition)
• Mycotic aneurysm- resulting in cerebral hemorrhage
• Janeway lesions= purpura
• Osler nodes (on the digits)
• Splinter hemorrhages under the nails
• Roth’s spots- retinal hemorrhages
• Splenomegaly
• Clubbing fingers

Question 5

the heart auscultation (endocarditis)

Answer 5

• changing of the character of a preexisting murmur or a new (regurgitant) cardiac murmur
• Tachycardia
• Ventricular gallop (CF)

Question 6

Diagnosis (Duke)- major criteria

Answer 6

• positive blood cultures
• vegetations
• new regurgitation
• abscess
• dehiscene of a prosthetic valve

Question 7

Clinical dg SIE

Answer 7

Valvulopathy plus prolonged fever

Question 8

Endocarditis prophylaxis

Answer 8

Antibiotic prophylaxis is recommended only for patients with the highest risk of IE undergoing the highest risk dental procedures.