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24 Cards in this Set

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What are risk factors for infective endocarditis?
• congenital heart disease
• diabetes
• infected shunts/IV lines
• IV drug users
• mitral valve prolapse
• post open heart surgery
• prosthetic heart valve
• renal disease
• rheumatic heart disease
• transient bactermia
• valvular abnormalities
What are common complaints of patients with infective endocarditis?
• chills
• fever
• heart murmurs
• loss of appetite
• musculoskeletal symptoms
• night sweats
• shortness of breath
• weakness
• weight loss
What are the 2 types of endocarditis? Which bacteria are associated with each type?
• acute: associated with Staph aureus
• sub-acute: associated with Strep viridens
What are peripheral manifestations of infective endocarditis?
• arthralgias
• Janeway lesions
• Osler nodes
• petechiae
• Roth's spots
• Splinter hemorrhages
• splenomegaly
Generally, what are types of procedures that can cause transient bactermia?
• dental
• lower GI
• upper respiratory
• urologic
What are splinter hemorrhages?
• linear, red-brown streaks
• most suggestive of endocarditis when proximal in nail beds
What are Osler's nodes?
2-5 mm painful nodules on pads of fingers or toes
What are Janeway's lesions?
macular, red or hemorrhagic, painless patches or palms or soles
What are Roth's spots?
oval, pale retinal lesions surrounded by hemorrhage
What diagnostic study is useful for identifying vegetations in endocarditis?
transesophageal echocardiogarphy
What is early prosthetic valve endocarditis? What is the bacterial cause?
• early PVE occurs within 60 days of surgery

• caused by:
- Staphylococcus epidermidids
- gram-negative enteric bacilli
- S. aureus
- Diphtheroids
What is the prophylactic regimens recommended for dental, oral, respiratory tract or esophageal procedures in susceptible patients?
• Amoxicillin 2 g 1 hr before procedure

• if allergic to PCN:
- Clindamycin 600 mg 1 hr before the procedure
OR
- Cephalexin 2 g 1 hr before the procedure
What are the HACEK organisms?
• Haemophilus
• Actinobacillus
• Cardiobacterium
• Eikenella
• Kingella
What are the major Dukes criteria?
• two positive blood cultures for an organism that causes infective endocarditis
• evidence of endocardial involvement shown by echocardiography
• development of a new regurgitant murmur
What are the minor Dukes criteria?
• fever
• immunologic processes (ex. glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor)
• positive blood cultures (not meeting the major criteria)
• presence of a predisposing condition
• serologic evidence of an active infection
• vascular processes (ex. cutaneous hemorrhages, aneurysms, systemic emboli, pulmonary infarction)
How long is the duration of antibiotic treatment for patients with endocarditis?
minimum 4-6 weeks
What are characteristics of right-sided endocarditis?
• seen in IV drug users
• tricuspid valve infection is most common
• may present pleuritic chest pain caused by septic pulmonary emboli
What is the treatment of endocarditis caused by Strep viridens or Strep Bovis?
PCN G/ampicillin ± Gentamicin
What is the treatment for endocarditis caused by Enterococcus?
PCN G/ampicillin + gentamicin
What is the treatment of endocarditis caused by Staph aureus?
Nafcillin OR Cefazolin OR Vancomycin ± gentamicin
What is the treatment of endocarditis caused by HACEK organisms?
• Ampicillin + genatmicin
OR
• ceftriaxone
What is the treatment of endocarditis caused by fungus?
Amphotericin B + surgery
What is the treatment of endocarditis caused by Pseudomonas?
Antipseudomonal PCN (ex. Ticarcillin) + Tobramycin
What are indications for surgical treatment of endocarditis?
• CHF refractory to medical therapy (most common indication)
• recurrent major systemic embolization