Infective Endocarditis

Question 1

What is infective Endocarditis

Answer 1

Infection of heart valves and other endocardial lined structures within the heart

Question 2

How do people catch infective endocarditis

Answer 2

1. Regurgitant or prosthetic valves infected

2. Introduce infectious material into the blood stream or directly onto the heart during surgery

Question 3

Clinical presentation of infective endocarditis

Answer 3

1. Depends on site
2. Signs of systemic infection (fever, sweats)
3. Embolisation (stroke, bone infections, MI)
4. Valve dysfunction (heart failure, arrhythmias)

Question 4

What is the modified Dukes Criterion for diagnosis

Answer 4

2 Major:

1. Bugs grown from blood cultures
2. Evidence of endocarditis on echo or new valve leaks

5 Minor:

1. Predisposing factors
2. Fever
3. Vascular Phenomena
4. Immune Phenomena
5. Equivocal blood cultures

Definite: 2 major, 1 major + 3 minor, 5 minors

Question 5

Pros of Transthoracic echo

Answer 5

Safe, non invasive

no discomfort

Question 6

Cons of TTE

Answer 6

Poor images so lower sensitivity

Question 7

Transoesophageal Echo pros

Answer 7

Clearer pictures

Question 8

Cons of Transoesophageal echo

Answer 8

Tube pushed down throat

Risk of perforation or aspiration

Question 9

What is peripheral stigmata

Answer 9

Splinter haemorrhages

Question 10

What are sober nodes

Answer 10

Tender nodules in the digits of a patient

Question 11

What are laneway lesions

Answer 11

Haemorrhages and nodules in the fingers of patients with infective endocarditis

Question 12

Characteristics of streptococci that cause infective endocarditis

Answer 12

Gram positive cocci in chains

Question 13

How do we identify Strep. viridian’s

Answer 13

Optochin resistant

Question 14

Types of colony made by strep. viridian’s

Answer 14

Alpha-haemolytic colonies

Question 15

Characteristics of Staphylococci that cause infective endocarditis

Answer 15

Gram positive
Cocci
clusters

Question 16

What test is performed on the Staphylococci being cultured overnight

Answer 16

1. Coagulase test - shows a positive result for staph. aureus

Question 17

How should staph. aureus respond to cefoxitin and penicillin

Answer 17

Resistance

Question 18

How should staph. aureus respond to vancomycin

Answer 18

Sensitivity

Question 19

What antibiotic is staph. aureus resistant to

Answer 19

cefoxitin - change to vancomycin

Question 20

What test is performed to confirm staphylococcus is present

Answer 20

Coagulase test

Negative - staphylococcus