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47 Cards in this Set

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Prerequisites for developing infective endocarditis
1) ABNORMAL OR DAMAGED ENDOTHELIUM

2) High flow and pressure

3) Transient bacteria

4) organisms with special characteristics - gram pos and oral bacteria
What usually causes a damaged endothelium?
Inflammation (ie., from rheumatic fever), trauma, or a virulent microorganism
Why are Gram-Positive Cocci more likely to cause infective endocarditis?
Staphylococci and Streptococci have proteins on their surface that bind fibrin, fibrinogen, fibronectin and platelets

Most gut gram-negative rods are susceptible to complement lysis in the blood (serum-sensitive)
What does the vegetation consist of?
fibrin-platelet clots that form where endothelium is damaged/abnormal
Only _____ and ____ cause endocarditis with great frequency due to their specific tropism and adherence
staph and strep
______ strep describe alpha hemolytic oral strep of multiple species
Viridans
Group of small, fastidious pleomorphic gram-negative coccobacilli that live in the moutha nd are associated with periodontal disease
HACEK
How do the Viridans strep and HACEKs enter the bloodstream?
Usually from the mouth after dental manipulations or in people with poor oral hygeine
How does Staph aureus enter the bloodstream?
Through minor skin break, inapparent infection, or a grossly infect wound. Drug addicts can also inject normal S aureus on the skin into the vein.
How does enterococci enter the bloodstream?
From the gut
Symptoms of subacute bacterial endocarditis
Vague and nonspecific - fever, malaise, fatigue. May have rheumatology, neurologic, renal, cardiac or pulmonary manifestations.
Classical way to dx SBE
1) positive blood cultures

2) predisposing, usually valvular, cardiac lesion

3) peripheral embolic phenomena
What test is used to dx SBE?
transesophageal echo
Endocarditis should be suspected in anyone with _________ bacteremia
S aureus
Most impt single factor in dxing endocarditis
+ blood cultures
T/F Blood cultures should be continuously positive in IE regardless of the time they are obtained
T
__ positive cultures are usually enough to dx IE, although ___ are usually obtained to cover contamination and fastidious organisms.
2-3; 6
How are blood cultures drawn?
In pairs - two separate sterile venipunctures drawn simultaneously from opposite arms.
How is the antibiotic determined?
It must be bactericidal because vegetations are protected from normal body defenses.

In vitro susceptibility testing must be performed.
How long is antibiotic therapy given?
Prolonged duration - at least two weeks, up to 6
T/F Antibiotic Therapy must be parenteral to assure continuous serum levels.
T
when is antibiotic prophylaxis tx given?
Whenever someone at high risk for IE undergoes a procedure associated with significant transient bacteremia (ie, dental work, oral surgery, etc.). These include persons with damaged, abnormal or prosthetic heart valves and those with certain congenital cardiac defects.
How do IV drug users differ from classical endocarditis?
They're younger, higher M:F ratio, lower prevalence of underlying structural heart disease.

It's predominantly <b>right-sided</b> with tricuspid involved in 80%.

80% is S. Aureus
Most common infecting organism in IV drug users
S. Aureus
Most common infecting organism in prosthetic valve endocarditis
S. epidermidis. They're hospital-acquired, almost always require surgical replacement.

Viridans strep are second.
Most gut gram-____ rods are susceptible to complement lysis in the blood (serum-sensitive)
negative
IV drug users are more likely to acquire IE on the ____ side while classically it occurs on the ____ side
Right; Left
What are causes of culture-negative endocarditis?
Prior treatment
Difficult-to-culture organisms: Bartonella henselae; Tropheryma whippelii; Coxiella burnetii; fungi
What are some important bactericidal abx for txing IE?
Beta-lactams (penicillins and cephalosporins)
Vancomycin
Aminoglycosides (gentamicin)
Fluoroquinolones (for RARE gram-negative endocarditis)
The “test of cure” for a patient with endocarditis is the ______ after therapy has been discontinued.
ABSENCE OF RELAPSE, not the disappearance of signs and sx.
T/F Cardiovascular disease is the leading cause of death in both genders
T
There is altered (systolic, diastolic) compliance with aging
diastolic
3 changes in CV system with age
diminished cardiovascular response to stress
altered diastolic compliance
alterations in response to therapies
the max heart rate (increases, decreases) with age
decreases
the max O2 uptake (increases, decreases) with age
decreases
How does the diastolic LV wall thickness change with aging?
Thickness increases
What is the impact of Preload Changes (EDV) on the Ventricular Performance in aging?
Resting left ventricular volumes increased in older subjects
Wide variations in preload produced a normal Frank-Starling response in both older and younger subjects
Presbycardia: defn
impaired cardiac function attributed to aging
How is preload changed in aging?
decreased
How is contractility changed in aging?
no change!
How is heart rate changed in aging?
attenuated at all levels of exercise.
How is afterload changed in aging?
no attenuation
What drugs are given to improve preload attenuation in aging?
Diuretics
Nitrates
T/F Digoxin usage decreases mortality
F
(Systolic, Diastolic) hypertension remains a significant independent cardiovascular risk factor
Systolic
Predominant sx of ischemic heart disease in elderly
dyspnea
For high risk pts, LDL < ___; for very high risk pts, LDL < ___
100; 70