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24 Cards in this Set
- Front
- Back
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What are risk factors for infective endocarditis?
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• 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 |
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What are common complaints of patients with infective endocarditis?
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• chills
• fever • heart murmurs • loss of appetite • musculoskeletal symptoms • night sweats • shortness of breath • weakness • weight loss |
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What are the 2 types of endocarditis? Which bacteria are associated with each type?
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• acute: associated with Staph aureus
• sub-acute: associated with Strep viridens |
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What are peripheral manifestations of infective endocarditis?
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• arthralgias
• Janeway lesions • Osler nodes • petechiae • Roth's spots • Splinter hemorrhages • splenomegaly |
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Generally, what are types of procedures that can cause transient bactermia?
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• dental
• lower GI • upper respiratory • urologic |
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What are splinter hemorrhages?
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• linear, red-brown streaks
• most suggestive of endocarditis when proximal in nail beds |
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What are Osler's nodes?
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2-5 mm painful nodules on pads of fingers or toes
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What are Janeway's lesions?
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macular, red or hemorrhagic, painless patches or palms or soles
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What are Roth's spots?
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oval, pale retinal lesions surrounded by hemorrhage
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What diagnostic study is useful for identifying vegetations in endocarditis?
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transesophageal echocardiogarphy
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What is early prosthetic valve endocarditis? What is the bacterial cause?
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• early PVE occurs within 60 days of surgery
• caused by: - Staphylococcus epidermidids - gram-negative enteric bacilli - S. aureus - Diphtheroids |
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What is the prophylactic regimens recommended for dental, oral, respiratory tract or esophageal procedures in susceptible patients?
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• 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 |
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What are the HACEK organisms?
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• Haemophilus
• Actinobacillus • Cardiobacterium • Eikenella • Kingella |
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What are the major Dukes criteria?
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• two positive blood cultures for an organism that causes infective endocarditis
• evidence of endocardial involvement shown by echocardiography • development of a new regurgitant murmur |
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What are the minor Dukes criteria?
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• 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) |
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How long is the duration of antibiotic treatment for patients with endocarditis?
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minimum 4-6 weeks
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What are characteristics of right-sided endocarditis?
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• seen in IV drug users
• tricuspid valve infection is most common • may present pleuritic chest pain caused by septic pulmonary emboli |
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What is the treatment of endocarditis caused by Strep viridens or Strep Bovis?
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PCN G/ampicillin ± Gentamicin
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What is the treatment for endocarditis caused by Enterococcus?
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PCN G/ampicillin + gentamicin
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What is the treatment of endocarditis caused by Staph aureus?
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Nafcillin OR Cefazolin OR Vancomycin ± gentamicin
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What is the treatment of endocarditis caused by HACEK organisms?
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• Ampicillin + genatmicin
OR • ceftriaxone |
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What is the treatment of endocarditis caused by fungus?
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Amphotericin B + surgery
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What is the treatment of endocarditis caused by Pseudomonas?
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Antipseudomonal PCN (ex. Ticarcillin) + Tobramycin
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What are indications for surgical treatment of endocarditis?
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• CHF refractory to medical therapy (most common indication)
• recurrent major systemic embolization |
