Infective Endocarditis

Front 1

1. what is inflammation of the hrt valves or lining of the heart due to infection ka?
2. What is 1's characteristic lesion?

Back 1

1. infective endocarditis
2. Vegetation - usu on valvular endothelial surface

Front 2

IE is due to damaged valves being colonized by sticky bacteria

Median age of onset is 58 yo, 1/3 are healthcare associated (IV lines), highest rates are in patients w/ prosthetic valves, intracardiac devices, unrepaired congenital cyanotic heart disease or previous hx of infective endocarditis

Back 2

Predisposition
- turbulent flow, RHD; IV drug user; bicuspid aortic valve, mitral valve prolapse, prosthetic valve

IE Dx requires 2 or 3 sets of blood cultures

Front 3

1. Most common pathogens in IE?
2. Clinical manifestations of IE?

Back 3

1. Staphylococci 2nd streptococci
2. FROM JANE
Fever; Roth spots; Osler nodes; Murmur (mitral); Janeway lesions; ANemia; N...; emboli

Front 4

Pathophysiology of IE
• Platelet-fibrin deposition on valve leads to nonbacterial thrombotic endocarditis
• Trauma to colonized tissue leads to bacteremia
• Bacteria adhere to platelet-fibrin aggregate
• Mature vegetation develops

Back 4

IE surgical indications: heart failure, uncontrolled infection, and prevention of embolic events

Front 5

1. If you see pulmonary emboli from an IE what valve is most likely
2. Most frequent and severe complications of IO involve what?
3. Organism implicated in 2?

Back 5

1. Tricuspid
2. Cerebral - stroke (ischemic & hemorrhagic), TIA, mycotic aneurysm, brain abscess, meningitis
3. Staph aureus - also large mobile or involving the mitral valve

Front 6

1. Test to run if IE is suspected?
2. Who should get prophylactic antibiotics?

Duke IE Dx criteria:
Stratified patients with IE into one of three categories: definite, possible, rejected

Back 6

1. Echocardiogram
2. invasive dental procedures in pts w/ prothetic valve, hx of previous IE or unrepaired cyanotic congenital hrt disease

Front 7

Clinical Diagnosis of IE
• Bacteremia or fungemia
• New or worsening cardiac murmur
• Signs of peripheral embolization
• Immunologic vascular phenomena

Back 7

Duke Pathologic Criteria
• Microbes demonstrated by culture or histopath exam of a vegetation, an embolized vegetation, or an intracardiac abscess
• Vegetation or intracardiac abscess confirmed as showing endocarditis on histopath

Front 8

Major IE clinical criteria
+ blood cultures; single blood culture w/ Coxiella burnetii or echocardiogram (intercardiac mass/abscess, dehiscence of prosthetic valve)

Back 8

Minor Clinical Criteria
• Predisposing condition or IV drug use • Fever (> 100.4 F) • Vascular phenomena: arterial embolism,
septic PE, mycotic aneurysm, ICH, conjunctival petechiae, Janeway lesions • Immunologic phenomena: GN, Roth spots, Osler’s nodes, RF
• Single positive blood culture or positive serology/PCR

Front 9

1. What does Coxiella burnetii cause?
2. what does it take to be definite IE by Duke?
3. Possible?
Reject if IE resolution w/ antibiotics in less than 4 days, no evidence at surgery of it

Back 9

1. Q fever
2. 2 major, or 1 major and 3 minor or 5 minor
3. 1 major and 1 minor or 3 minor

Front 10

1. Is transesophageal echo or transthoracic echo mores sensitive?

pt w/ strep bovis should undergo colonoscopy to r/o colon Ca or other mucosal lesion

Back 10

1. Transesophageal for vegetations and abscesses... a negative transthoracic does not definitely r/o IE

Front 11

1. Coagulase - staph are associated w/ what in IE?
2. most common cause of IE in developed world?
3. Valve often involved in drug users?

Back 11

1. Prosthetic valve - staph epidermidis; staph lugdunensis is more virulent, often have MVP
2. Staph aureus due to healthcare (UIV)
3. tricuspid

Front 12

Prosthetic valve endocardiits often given vanco, gentamicin, rifampin -- surgery often required

Enterococci - need 2 drugs to treat - vanco and gentamicin both oto and neprhotoxic so be careful

Back 12

IE due to HACEK Organisms - do not culture well
• Haemophilus species • Actinobacillus • Cardiobacterium • Eikenella • Kingella

Salmonella common cause of Non HACEK

Front 13

Culture-negative IE
• Coxiella burnetii • Bartonella species • Nutritionally variant Strep • Mycoplasma hominis • Legionella
• Tropheryma whipplei • Brucella

Back 13

Surgical therapy for IE: valve replacement for those w/ staph aureus

Front 14

1. When is Coxiella Burnetti (Q fever) really spread?
2. Echo findings? - use serologic stuides and PCR
3. Most common etiologic agent of Rt sided IE in IDU?
4. culprit in fungal IE?

Back 14

1. Pregnancy of infected animals - ranchers are at risk
2. nonspecific wall thickening
3. Staph aureus usu of the tricupsid valve
4. candida, invades myocardium, usu need surgery

Front 15

Indications for surgery in IE include heart failure, uncontrolled infection, and prevention of embolic events

Back 15

Most Common Causes of Death Related to IE
• Congestive heart failure • Neurologic events
• Septic complications • Embolic phenomena
• Rupture of mycotic aneurysm
• Complications of cardiac surgery
• Lack of response to antibiotics • Prosthetic valve IE