Term
| what is infective endocarditis? |
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Definition
infection of cardiac valves/endocardium
-bacterial vegetations
=new murmur + fever = IE until proven otherwise! |
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Term
| What are the 2 clinical types of infective endocarditis and how are they different? |
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Definition
ACUTE
high virulence organsisms - stap aur
rapid infection
little host response
SUBACUTE
lower virulence orgs
slower infection
host inflamm response = granulation tissue |
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Term
| What are the causative agents of IE? |
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Definition
Staph aureus
Strep viridans - own flora, tonsilectomy
Staph epidermis - cardiac surgery
enterococcus faecalis - prostate probs |
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Term
| What compromises a "vegetation"? |
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Definition
fibrin
bacteria (agglutinated by circulating abs)
platelets |
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Term
| Describe the pathology of acute IE |
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Definition
vegetations start small and enlarge
destruction of valve leaflets and surrounding struc eg ch.tendinae
spread to other parts of mycardium = ring abscess
systemic emboli |
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Term
| Describe the pathology of subacute IE |
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Definition
slow growing vegetation
firmer = less destruction
inflammation = granulation tissue and inflamm infiltrate. |
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Term
|
Definition
Infection=
-fever
-malaise
-splenomegaly
-rigors
-night sweats
-clubbing
Cardiac Lesion
-dev of new murmur
-change in existing murmur
-LVHF
Vascular Lesions
-mucosal haemorrhage
-janeway lesions (unpainful)
-oslers nodes (paniful)
-splinter haemorrhage
-embolic phenomena
-renal lesions |
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Term
| What investigations would you do if you suspect IE? |
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Definition
Blood cultures
-from 3 diff sites at diff times
-persistent bacteraemia = key feat
Blood
-inc ESR/CRP
-thrombocytopenia
-ACD
LFT's = inc alk phos
Urine - proteinuria/haematuria
Echo
ECG
CXR |
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Term
|
Definition
Bacteriocidal antibiotics
-IV
-in combo
start blind then based on culture/sensitivity
eg b.penycillin+gentamycin
or
vancomycin+gentamycin
Surgery = last resort |
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Term
| which patients need prophylaxis against IE?! |
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Definition
-congential HD
-previous Hx of IE
-Valvualr heary disease
-Prosthetic heart valve |
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Term
| what antibiotics would you use in prophylaxis of IE? |
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Definition
| amoxycillin or clindomycin if allergic |
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Term
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Definition
IVDA's - RHS
Infection elsewhere
Dental/surgerical procedures
Cannula (dont swab skin)
trivial injuries - eg brushing teeth |
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Term
| Who is at risk of developing IE? |
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Definition
-IVDA's
-Pre-exisitng cardiac abnormality causing haemodynamic injury (VSD?calcific change/RF/MVP)
-Prosthetic H valves |
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