Describe the 4 steps in formation of vegetations in endocarditis
- Alteration of valvular surface
- Deposition of platelets & fibrin
- Colonisation by bacteria
- Development of vegetation
Classic triad presentation of endocarditis
- Persistent pyrexia of unknown origin
- New/changing murmur
- Embolic phenomena
Non-specific symptoms of heart failure
- Temperature >38C, Night sweats
- Fatigue, muscle & joint pain
- Unexplained weight loss
- Dyspnoea
- Vomiting, headache, coma, delirium
According to Duke’s criteria, what is a definite diagnosis of endocarditis (how many major/minor)
- 2 major criteria OR
- 1 major + 2 minor OR
- 5 minor
Which bacteria, if found in a single blood culture, is sufficient for diagnosing endocarditis
Coxiella burnetii
What are the major Duke’s criteria (2 criteria)
- blood cultures positive for endocarditis
2. evidence of endocardial involvement (on ECHO)
What are the minor Duke’s criteria (6 criteria)
- predisposing heart condition
- IVDU
- fever
- vascular phenomena
- immunological phenomena
- other microbiological evidence (that doesn’t meet major criteria)
What are embolic phenomena in endocarditis
o Arterial emboli (major) o Septic pulmonary infarcts o Mycotic aneurysm o Intracranial bleed o Conjunctival bleed o Janeway’s lesions
What are vascular phenomena in endocarditis
o Glomerulonephritis
o Osler’s nodes
o Roth’s spots
o Rheumatoid factor
What are lifestyle-related risk factors for infective endocarditis
- IVDU
- Body piercings
- Tattoos
What medical history are risk factors for infective endocarditis
- poor oral hygiene
- invasive dental work
- hx of endocarditis
- immunocompromised
- rheumatic heart disease
- congenital heart conditions
- haemodialysis
- anything causing bacteriamia eg colon cancer, serious UTI
What valve problems are risk factors for infective endocarditis
- stenosis or regurgitation in any of the 4 valves
- artificial heart valves
- age related degenerative valvular lesions
Complications of infective endocarditis
- heart failure
- valve abscess (may lead to heart block)
- embolisms
- pericarditis
- glomerulonephritis (autoimmune side effect)
Which sided endocarditis occurs more in IVDU
R sided
Which sided endocarditis occurs more in cocaine users
L sided
Which sided endocarditis is more severe
L sided often has worse outcomes
L sided is also more common
Janeways lesions vs Oslers nodes - which is painful
Janeways lesions are painless
Oslers nodes are painful
What causes Roth spots
Mixture of fibre and platelet deposition
Most common bacterial causes of infective endocarditis
- Staph aureus
- Strep viridians
Most common valve involved in infective endocarditis
Mitral
Where + timing to get blood cultures from in a chronic/subacute presentation
3 different sites
6h apart
Where + timing to get blood cultures from in an acute presentation
2 different sites
within 1h
