cardiovascular > endocarditis > Flashcards

endocarditis Flashcards

(57 cards)

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1
Q

what is it

A

endovascular infection of cardiovascular structures including cardiac valves, atrial and ventricular endocardium, large intrathoracic vessels and intracardiac foreign bodies

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2
Q

consequence of what 2 things

A
  • presence of organism in blood stream

- abnormal cardiac endothelium

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3
Q

what can bacteraemia arise

A
  • poor dental hygiene
  • IV drug ise
  • soft tissue infections
  • dental treatment
  • cardiac surgery
  • pacemakers
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4
Q

does bacteraemia always result in endocarditis

A

no

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5
Q

what does damaged endocardium promote

A

platelet and fibrin deposition

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6
Q

what does increase platelet and fibrin deposition allow

A

organisms to adhere and grow, leading to an infected vegetation

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7
Q

what valves are most commonly involved

A

aortic and mitral

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8
Q

what valves are usually affected in drug users

A

right sided

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9
Q

what organisms affect the mouth

A
  • alpha haemolytic viridian’s streptococci
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10
Q

what organisms are caused by vascular catheters and antibiotic use

A

staph aureus

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11
Q

what organisms affect the gut and perineum

A

enterococci

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12
Q

what organism affect bowel malignancy

A

strep. bovis

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13
Q

what organism affect early disease of native valve replacements

A
  • staph aureus

- staph epidermis

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14
Q

what organism affect late occurring endocarditis due to valve replacements

A
  • strep viridian’s

- staph aureus

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15
Q

who is most likely to get soft tissue infections

A
  • diabetics
  • IVDUs
  • catheters
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16
Q

what organism affects soft tissue infections

A

staphylococci

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17
Q

what are rare causes of endocarditis

A

HACEK groups of organism

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18
Q

how bad are the HACEK group

A

very insidious

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19
Q

what criteria is used

A

Duke

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20
Q

what is usual cause of culture-negative endocarditis

A

prior antibiotic therapy

some duet to variety of fastidious organisms that fail to grow

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21
Q

what are examples of organism that cause gram-negative

A
  • coxiella brunetti
  • chlamydia
  • bartonella
  • legionella
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22
Q

symptoms

A
  • malaise (95%)
  • clubbing (10%)
  • murmurs (90%)
  • cardiac failure (50%)
  • arthralgia (25%)
  • pyrexia (90%)
  • osler nodes (15%)
  • splinter haemorrhages (10%)
  • janeway lesion (5%)
  • petechiae (50%)
  • Roth spots (5%)
  • splenomegaly (40%)
  • cerebral emboli (20%)
  • ## haematuria (70%)
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23
Q

what symptoms give high clinical suspicion

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A
  • new valve lesion/murmur
  • embolic events of unknown origin
  • sepsis of unknown cause
  • haematuria and suspected renal infarction
  • fever plus prosthetic material in heart, IV drug user, positive blood culture
24
Q

what is major criteria for diagnosis

Study These Flashcards
A
  • positive blood culture
  • positive serological test for Q fever
  • echo
  • new valvular regurgitation
25
what is seen on echo
- an oscillating intracardiac mass on the valve or supporting structures - an abscess
26
what is minor criteria for diagnosis
- predisposing heart condition - predisposing IV drug use - fever - intracranial haemorrhage - laneway lesion - osler nodes - Roth spots - positive blood culture but not for criteria -
27
what are the HACEK organisms
- haemophilus - actinobacillus - cardiobacgerium - eikenella corrodens - kingella kingae
28
what is very useful for diagnosis
echo
29
what investigations should be done
- blood culture - serological test - FBC - urea and electrolytes - liver biochemistry - inflammatory markers - urine - echo - CXR - ECG
30
how is blood culture done
3 sets from different venepuncture sites
31
when should serological tests be considered
culture negative cases for coxiella, legionella, chlamydia
32
what is FBC
- haemoglobin - increase white blood cells - increased or reduced platelets
33
what is seen in liver biochemistry
increased serum alkaline phosphatase
34
what seen in ECG
- PR prolongation | - heart block
35
what is seen on CXR
- pulmonary oedema in left-sided disease - pulmonary emboli - abscess in right side
36
length of antibiotic treatment
usually prolonged
37
how long is the antibiotic treatment
4-6 weeks
38
when do serum levels need to be monitored to prevent toxicity
- gentamicin | - vancomycin
39
what is used if patient has penicillin allergy
- glycopeptides - vancomycin - teicoplanin
40
what antibiotic is fundamental for therapy
penicillin
41
treatment when results awaiting and no suspicion of staphylococci
- penicillin | - gentamicin
42
treatment for suspected staphylococcal endocarditis | recent surgery, acute infection
- vancomycin | - gentamicin
43
treatment for streptococcal endocarditis (penicillin-sensitive)
- penicillin | - gentamicin
44
treatment for enterococcal endocarditis
- amoxicillin | - gentamicin
45
treatment for staphylococcal endocarditis
``` - vancomycin or flucloxacillin or benzypenicilin plus gentamicin ```
46
when should most patients with endocarditis respond
within 48 hours of antibiotic therapy
47
what is the evidence of resolution
- reduced fever - reduction in serum markers of infection - relief of systemic symptoms of infection
48
if there is no sign of resolution what may be happening
- extension of infection - hospital-acquired infection - PE
49
Is antibiotic prophylactic therapy required
no
50
what is most common cause
staph aureus
51
what causes it after dental work
viridians streptococci
52
when do you always consider endocarditis
new murmur + fever
53
treatment if caused by staph aureus
flucloxacillin
54
treatment if caused by MRSA
vancomycin + rifampicin
55
treatment if caused by viridian's
benzylpenicillin + gentamicin
56
treatment if caused by enterococcus
amoxicillin/vancomycin + gentamicin
57
treatment if caused by staph epidermidis
vancomycin + gentamicin + rifampicin
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