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21 Cards in this Set
- Front
- Back
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risk factors for endocarditis
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• Prosthetic heart valves
• Previous history of IE • Congenital heart disease • Rheumatic heart disease • IVDA • Hypertrophic cardiomyopathy • Mitral valve prolapse with regurgitation • Central venous catheters • Hemodialysis access |
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pathophysiology of endocarditis
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• Prosthetic heart valves
• Previous history of IE • Congenital heart disease • Rheumatic heart disease • IVDA • Hypertrophic cardiomyopathy • Mitral valve prolapse with regurgitation • Central venous catheters • Hemodialysis access |
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causes of bacteremia
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• Dental procedures
• Upper airway manipulation/surgery • GI surgery/procedures • Urology procedures • OB/GYN surgery |
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key pathogens in endocarditis
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• Streptococci viridians (native or old valves)
• S. aureus (new prosthetic valve, IVDA) • Coagulase negative staph • Enterocci • Culture negative HACEK o Hemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella |
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embolic complications of endocarditis
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• Osler nodes (hands and feet)
• Janeway lesions (hands and feet) • Splinter hemorrhages (fingernails) • Petechiae • Roth spots (under eyelid) • Clubbing |
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acute S/S of endocarditis
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high fever
elevated WBC acute s/s HF |
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subacute S/S of endocarditis
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low-grade fever
night sweats weight loss peripheral manifestations |
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in endocarditis, patients complain of
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fever, chills, weakness, dyspnea, sweats, anorexia, weight loss, malaise, cough, skin lesions, stroke, N/V, HA, myalgia, arthralgia, edema, CP, abd pain
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in endocarditis, PE findings are:
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fever, new/changing heart murmur, embolic phenomenon, skin manifestations, splenomegaly, septic complications, clubbing, retinal lesion, signs of renal failure
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in endocarditis, lab findings are
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WBC elevated
anemia PERSISTENTLY POSTIIVE BLOOD CULTURES |
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2 types of echos
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• TEE (esophageal) sensitivity 90-100%
• TTE (thoracic) sensitivity 58-63% • Lack of vegetation found on TTE or TEE doesn’t rule out IE |
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2 major Duke criteria
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o Positive blood cultures - Typical organisms, persistent bacteremia, ¾ blood cultures
o Evidence on ECHO: abscess, vegetation, dehiscence of PV, new valvular regurgitation |
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2 minor Duke criteria
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o Predisposition, fever, vascular phenomena, immunologic phenomena, ECHO findings, microbiologic findings (not in 3 of 4 cultures)
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diagnosis of IE
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• Pathologic criteria (rarely done) – bacteria found in vegetation
• Clinical criteria o 3 major o 1 major + 3 minor o 5 minor |
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Tx guidelines for endocarditis
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• CIDAL
• Penetration into vegetation • Activity against offending organism (organism almost always known) • Extended duration (4-6 weeks) |
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Tx for native valve + S. viridans
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-PCN 12-18 MU d in 4-6 dd
-ceftriaxone 2 g qd -PCN + gent 1 mg/kg q 8 h -vanco 30 mg/kg/d in 2 dd DURATION IS 4 WEEKS (except gent is 2) |
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Tx for native valve + S. aureus
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-naf/oxacillin 2 g IV q 4 h
-cefazolin 2 g IV q 8 h -vanco 30 mg/kg/d in 2 dd DURATION IS 4-6 WEEKS |
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Tx for prosthetic valve + S. aureus
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-vanco + rifampin + gent
-naf/oxacillin + rifampin + gent DURATION IS 6 WEEKS (2 weeks for gent component) |
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Tx for enterococcus (regardless of valve type)
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-ampicillin 12 g/d + gent
-vancomycin + gent DURATION IS 4-6 WEEKS, including gent |
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Tx for HACEK organisms
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ceftriaxone or ampicililn
+ gent |
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Tx for fungal endocarditis
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caspofungin
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