The Cardiovascular System > Endocarditis > Flashcards

Endocarditis Flashcards

(49 cards)

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1
Q

Normally, blood is ________

A

Sterile

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2
Q

What is bacteraemia?

A

The presence of bacteria in the blood

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3
Q

What is septicaemia?

A

The presence and multiplication of bacteria in the blood

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4
Q

What is infective endocarditis?

A

Infection of the heart valve endothelium

This cause valve irregularities which leads to turbulent blood flow

Valve irregularities may break free and pass into the blood

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5
Q

What are the risk factors for infective endocarditis?

A
  • Any heart valve abnormality - calcification/sclerosis, congenital, post rhematic fever
  • Prosthetic heart valaves
  • IV drug users
  • Intravascular lines
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6
Q

How does endocarditis come about?

A

There is damage to the heart valve causing turbulent blood flow

This causes deposition of platelets and fibrin

In infcetive endocarditis, microbial vegetations can settle within the platelet/fibrin thrombi

These can break off and form blockages in capillary beds

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7
Q

Bacteraemia can come about after ________ treatment

A

Dental

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8
Q

Which side of the heart is most often affected by endocarditis?

A

Left side

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9
Q

Which organisms are most likely to cause infective endocarditis?

A
  • Staph aureus (38%)
  • Step viridans (31%)
  • Enterococcus sp (8%)
  • Staph epidermidis (6%)
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10
Q

What are some more unusual examples of organisms that can cause endoarditis?

A
  • Atypical organisms
    • Bartonella, Coxiella burnetii (Q-fever), Chlamydia, Legionella, Mycoplasma, Brucella
  • Gram-negatives
    • HACEK organisms
      • Haemophilus spp. , Aggregatibacter spp**, Cardiobacterium, Eikenella sp., Kingella sp.
    • Non-HACEK gram negatives
  • Fungi
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11
Q

Why are atypical organisms hard to diagnose as the cause of endocarditis?

A

They are hard to culture, and are slow to grow

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12
Q

How often should blood cultures be taken during treatment of endocarditis?

A

Every 2-3 days until the results are negative

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13
Q

How is endocarditis diagnosed?

A
  1. Firstly a transoesophageal echo is taken
  2. The result (positive or negative) from this is confirmed by the more accurate transthoracic echo
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14
Q

What is the coagulase test?

A

Coagulase is an enzyme produced by S.aureus which converts soluble fibrinogen to insoluble fibrin

If fibrin is produced in this test S.aureus is present, and if it is not another form of staphylococcus is present

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15
Q

What is the most common coagulase negative test result for?

A

Staphylococcus epidermidis

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16
Q

Where is S.epidermidis likely to come from?

A

It can infect metal and plastic (prosthetic material) such as IV lines, prosthetic heart valves and joints.

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17
Q

What is MALDI TOF?

A

A machine that can identify the species of microorganism and most relevant treatment

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18
Q

How does acute endocarditis present clinically?

A

Cardiac failure and overwhelming sepsis

There is poor organ functiondue to lower blood pressure

Aggressive and virulent pathogens such as S.aureus cause this

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19
Q

How does subacute endocarditis differ from acute endocarditis?

A

It has a slower onset

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20
Q

Whaat are typical symptoms of subacute endocarditis?

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A
  • Fever
  • Malaise
  • Weight loss
  • Tiredness
  • Breathlessness
21
Q

What are typical signs of subacute endocarditis?

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A
  • Fever
  • New or changing heart murmur
  • Finger clubbing
  • Splinter haemorrhages
  • Splenomegaly
  • Roth spots, Janeway lesions, Osler’s nodes
  • Microscopic haematuria
22
Q

Subacute endocarditis is often cause by which bacterial group?

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A

Streptococcus viridans

23
Q

Generally the Strep viridans group will be _____ haemolytic

24
Q

When diagnosing endocarditis, how many blood cultures should be taken?

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A

3

(this rules out contaminents easier)

25
When blood cultures are negative, which other test may find more unusual or atypical organisms?
Serology
26
Prosthetic valve endocarditis can have both early and late presentations, differentiate between the likely causes of the two
Early - Infected at the time of valve insertion - usually S.aureus or S.epidermidis Late - Infected many years after valve insertion due to coincidental bacteraemia, this can be due to many bacteria
27
Why is the right side of the heart most affected by endocarditis in IV drug users?
The venous system is used for IV drug use, so bacteria will arrive firstly at the right side of the heart
28
Which heart valve is most likely affected by endocarditis in IV drug users?
Tricuspid
29
When S.aureus affects the tricuspid valve in an IV drug user causing endocarditis, what is a serious condition that may result?
Multiple septic pulmonary emboli released
30
How is endocarditis treated if the native valve is infected?
Amoxicillin and gentamicin IV
31
How is endocarditis treated if a prosthetic valve is infected?
* Vancomycin and gentamicin (IV) * Rifampicin (after 3-5 days, more effective at lower bacterial load) * Potential valve replacement
32
How is IV drug users' endocarditis treated?
Flucloxacillin IV
33
How is S.aureus treated in relation to endocarditis?
Flucloxacillin IV
34
How is viridans streptococci treated in relation to endocarditis?
Benzylpenicillin IV and gentamicin IV
35
How is S.epidermidis treated in relation to endocarditis?
Vancomycin and gentamicin IV and rifampicin
36
What must be monitored during antibiotic treatment for endocarditis?
1. Cardiac function 2. Temperature 3. Serum C-reactive protein
37
Which organs will endocarditis primarily affect?
* Brain * Kidneys * Spleen Lungs are only effected rarely or with IV drug users
38
What is marantic endocarditis?
This is nonbacterial thrombotic endocarditis which is an autoimmune disease Vegetations on the heart are sterile
39
What is myocarditis?
Condition common in young people involving inflammation and damage to the heart muscle
40
What are symptoms of myocarditis?
* Fever * Chest pain * Breathessness * Palpitations
41
What are signs of myocarditis?
* Arrhythmia * Cardiac failure
42
Which pathogens can cause myocarditis?
* Coxsackie A and B * Echovirus * Influenza * Adenovirus
43
How is myocarditis diagnosed?
* Viral PCR * Throat swab (check for influenza) * Stool (check for enteroviruses)
44
What can often happen when an immune reaction is provoked in myocarditis?
An autoimune condition will result and dilated cardiomyopathy will result This will lead to arrhythmias and sudden death
45
What is pericarditis?
Inflammation of the pericardium
46
Pericarditis can often occur alongside what ther condition?
Myocarditis
47
What is usually the cause for pericarditis?
Viral causes such as: * Coxsackie * Adenoviruses * Influenza * Pneumococcus
48
What is the main symptom of pericarditis?
Chest pain
49
What can happen in pericarditis when bacteria are the cause?
Pus can build up in the pericardial space which is as a result of post cardiac surgery.
The Cardiovascular System
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