Define it
Infection of the endocardium that typically affects 1 or more heart valves
Which groups is it most common in? (2)
- Males
- Over the age of 60
Risk factors? (6)
- Previous episode of endocarditis (strongest RF)
- Rheumatic valve disease
- Prosthetic heart valves
- Dental procedures
- IV drug use (more likely to present with right sided valve problems)
- Congenital heart defects
List the valves in the order of likeliness of being affected from most to least
MATP
- Mitral valve
- Aortic valve
- Tricuspid valve
- Pulmonary valve
What is the most common causative agent of acute infective endocarditis?
Staphylococcus aureus
Which valve is most likely affected in IV drug use?
Tricuspid
List risk factors for infective endocarditis caused by staph. aureus (2)
- Patients with prosthetic valves
- IV drug use
What is commonly the causative agent if <2 months post valve surgery?
Staphylococcus epidermidis → after 2 months S aureus is more common again
What is the most common causative agent of subacute infective endocarditis?
Streptococcus viridans
affect Predamaged native valves
commonly caused by dental procedures
What causative agent is also linked to colorectal cancer?
Streptococcus bovis
What are non infective causes of endocarditis? (2)
- SLE → Libman-Sacks endocarditis
- Malignancy (marantic endocarditis)’
Clinical features
- Fever/chills
- New heart murmur
- Dyspnoea on exertion
What may you find on examination? (5)
- Splinter haemorrhages (under fingernails)
- Janeway lesions (painless macule on palms and soles)
- Osler nodes (painful nodules on finger and toes)
- Clubbing
- Roth spots (white centred retinal haemorrhage on fundoscopy caused by septic emboli)
What investigation
3 sets of Blood cultures
- Repeat 4-72hr after treatment starting to check effectiveness
What is the most sensitive diagnostic test?
Trans-thoracic echocardiogram- show valvular, mobile vegetations
In what cases would you do a trans-oesophageal echocardiogram? (2)
- Prosthetic heart valve
- If trans-thoracic echocardiogram comes back negative
What is the criteria for definite IE?
Dukes criteria → 2 majors OR 1 major + 3 minors OR all 5 minors
List the 2 Major Dukes criteria
2 blood culture positive for IE
Imaging positive for IE (Echocardiogram, PET-CT, Cardiac CT)
List the 5 Minor Dukes criteria
- Predisposing heart condition or IVDU
- Fever >38°C
- Vascular phenomena such as- Arterial emboli, infarcts, intracranial or conjunctival haemorrhages, Janeway lesions
- Immunological phenomena such as osler’s nodes, roth’s spots, RF, glomerulonephritis
- microbiological evidence
what is the management for IE
Long term IV antibiotics for minimum 6 weeks
Management for suspected IE
-Supportive care (fluids and oxygen)
-Broad-spectrum (empirical) antibiotics. Amoxicillin. Vancomycin if allergic or MRSA or severe sepsis
Management for suspected IE of their prosthetic valve
vancomycin + rifampicin (broad spectrum antibiotics) + low dose gentamicin Iusws to treat hospital acquired bacterial infections)
What is the management for s. aureus, if patient has a native valve?
Flucloxacillin (to treat bacterial infections caused by staphylococci and streptococci, such as skin, wound, bone, and chest infections (e.g., pneumonia)
What is the management for s. aureus, if patient has a prosthetic valve? (3)
Flucloxacillin + Rifampicin + Low dose gentamicin
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Aortic Dissection22
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Aortic Aneurysm23
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Acute Coronary Syndromes28
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Stable angina18
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AF40
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Ventricular diseases27
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Heart block20
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Wolff-Parkinson white5
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Supraventricular tachycardia17
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Infective endocarditis30
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Venous Ulcers8
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Arterial ulcers13
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Pericardial Disease24
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PE20
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Vasovagal syncope6
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Deep vein thrombosis19
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Cardiac failure28
