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18 Cards in this Set
- Front
- Back
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How many criteria (minor and major) must be met to meet Duke's criteria?
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2 major, 1 minor
1 major, 3 minor or 5 minor |
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What are the two major criteria for Duke's?
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1. Two positive blood cultures with
-Staph aureus -Viridans strep, Strep bovis/epidermis, enterococci, gram - rods, Candida HACEK organisms are generally culture-negative (Haemophilus aphrophilus/parainfluenzae, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae) 2. Abnormal echocardiogram -Intracardiac mass or valvular vegetation OR -Abscess OR -New partial dehiscence of prosthetic valve |
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What are the minor criteria for Duke's?
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Fever (>38oC), Presence of risk factors, Vascular findings, Immunological findings, Microbiologic findings
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What are the risk factors for infective endocarditis?
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IV drug use (IDU), presence of structural heart disease, prosthetic heart valve, dental procedures involving bleeding, h/o of endocarditis
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What are the vascular findings for infective endocarditis?
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Janeway lesions, spetic pulmonary infarcts, arterial emboli, mycotic aneurysm, conjunctival hemorrhage
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What are the immunological findings of infective endocarditis?
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Roth spots, Osler's nodes, Glomerulonephritis
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What are the microbiologic findings of infective endocarditis?
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Positive blood culture but does not meet major criteria
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What patient risks should be looked at when considering endocarditis infection?
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Prosthetic heart valve, injection drug use, dental procedures that cause bleeding, previous endocarditis, unprepared or recently repaired cyanotic heart disease
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What does fever + murmur point towards?
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Possible endocarditis, do blood cultures. If blood cultures are +, then do echocardiogram.
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What does 2 + blood cultures and 1 + Echo mean?
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Endocarditis
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What should be done if TTE is - and endocarditis is highly suspected?
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TEE
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What is the best empiric therapy for endocarditis?
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Vancomycin and gentamicin in combination (will cover most common organisms, which are S. aureus, MRSA, and viridans group streptococci. Tx is usually for 4-6 weeks.
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If + blood culture for S. bovis, what should be done?
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Perform colonoscopy
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When is surgery (valve replacement) indicated for infective endocarditis?
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With anatomical defects (valve rupture, abscess, prosthetic valves, fungal endocarditis, embolic events once already started on antibiotics)
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What are the only cardiac defects that need endocarditis prophylaxis?
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Prosthetic valves, un-repaired cyanotic heart disease, previous endocarditis, transplant recipients who develop valve disease
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What are the only procedures that need prophylaxis?
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-Dental procedures that cause bleeding (usually antibiotic is amoxicillin. For penicillin-allergic patients, clindamycin is the drug of choice.
-Respiratory tract surgery -Surgery of infected skin |
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What procedures do not need endocarditis prophylaxis?
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Dental fillings, all flexible scopes, all OB/Gyn procedures, all urinary procedures including cystoscopy
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What cardiac defects do not need prophylaxis?
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AS & AR, MS & MR, ASD & VSD, Pacemakers and ICDs, MVP even w/ a murmur, HOCM
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