Term
| Infective endocarditis (IE) is what? intracardiac effects? systemic effects? |
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Definition
• Infective endocarditis (IE) is an infection of the endocardial surface of the heart.
• The intracardiac effects include severe valvular insufficiency
– May lead to congestive heart failure and myocardial abscess
• Also produces a wide variety of systemic signs and symptoms through several mechanisms
– Both sterile and infected emboli and various immunological phenomena. |
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Term
| etiology of infective endocarditis, organisms |
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Definition
| staph aureus, strep viridas, strep intermedius, nonenterococcal group d organisms, group b strep, group a c g strep, coag neg s. aureus, pseudomonas aeruginosa, haemophilus aphrophilus, actinobacillus actinomycetemcomitans, cardiobacterium hominis, eikenella corrodens, kingella kingae, candida albicans, candida parapsilosis, candida tropicalis, aspergillus |
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Term
| acute endocarditis and common organisms |
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Definition
• Usually occurs when heart valves are colonized by virulent bacteria.
• The most common cause of acute endocarditis is Staphylococcus aureus; other less common causes are Streptococcus pneumoniae, Neisseria gonorrhoeae, Streptococcus pyogenes, and Enterococcus faecalis. |
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Term
| subacute endocarditis and common organisms |
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Definition
| • Usually have underlying valvular heart disease and are infected by less virulent organisms such as viridans streptococci, enterococci, nonenterococcal group D streptococci, microaerophilic streptococci, and Haemophilus species. |
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Term
| acute endocarditis findings |
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Definition
• Acute
– Affects normal heart valves
– Rapidly destructive
– Metastatic foci
– Commonly Staph.
– If not treated, usually fatal within 6 weeks |
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Term
| subacute endocarditis findings |
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Definition
• Subacute
– Often affects damaged heart valves
– Indolent nature
– If not treated, usually fatal by one year |
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Term
| invasive procedures that can cause bacteriemia and organisms |
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Definition
• Endoscopy
– Rate of 0-20%
– CoNS, streptococci, diphtheroids
• Colonoscopy
– Rate of 0-20%
– Escherichia coli, Bacteroides species
• Barium enema
– Rate of 0-20%
– Enterococci, aerobic and anaerobic gram- negative rods
• •
Dental extractions – Rate of 40-100% – S viridans
Transurethral resection of the prostate
– Rate of 20-40%
– Coliforms, enterococci,
S aureus
Transesophageal echocardiography
– Rate of 0-20%
– S viridans, anaerobic organisms, streptococci |
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Term
| pathophysiology of infective endocarditis |
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Definition
• The clinical manifestations of IE result from:
– Local destructive effects of intracardiac infection (distortion or perforation of valve leaflets, rupture of chordae tendineae, perforations or fistulas between major vessels and cardiac chambers, functional valvular stenosis) with congestive heart failure;
– Embolization of fragments of the vegetation, resulting in infection or infarction including the spleen, kidney, meninges, brain, bone, pericardium, synovium;
– The hematogenous seeding of remote sites during continuous bacteremia (hyper-gammaglobulinemia, cryoglobulins, splenomegaly);
– Immunologic response to the infection with tissue injury due to deposition of preformed immune complexes or antibody- complement interaction with antigens deposited in tissues (glomerulonephritis, Osler’s nodes, rheumatological manifestations). |
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Term
| peripheral manifestations of infective endocarditis |
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Definition
• Splinter hemorrhages (A) are normally seen under the fingernails.
• Conjunctival petechiae noted in B
• Osler's nodes (C) are tender, subcutaneous nodules, often in the pulp of the digits Janeway lesions (D) are non- tender, erythematous, hemorrhagic/pustular lesions |
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Term
| non-cardiac manifestations of infective endocarditis |
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Definition
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Term
| lab findings of infective endocarditis |
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Definition
• Anemia 70-90%
• Leukocytosis 20-30%
• Microscopic hematuria 30-50%
• Elevated sedimentation rate >90%
• Rheumatoid factor 50%
• Circulating immune complexes 65-100% • Decreased serum complement 5-40% |
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Term
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Definition
Now some of the tests of choice here. One includes an echocardiogram. It's probably the test of choice along with blood cultures. Blood cultures are really important because it's going to identify what the organism is to help you identify all those ideological agents we talked about. But echo will show you the vegetations.
This is just an example of a vegetation on a mitral valve seen there. You can see it in a close up photo right here. All those vegetations. And then what it would look like, the same thing, on the echo. You're not going to have to read echos, but just know that echo is a great way to look for these vegetations on the different valves.
This is just another example of a mitral valve vegetation, you can see pointed there. This just shows the mitral valve in a patient with endocarditis. |
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Term
| duke criteria for infective endocarditis, major and minor criteria |
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Definition
[image]
So to make the diagnosis of infectious endocarditis you can either have two majors, you can have one major with three minors, or you can have five minors |
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Term
| endocarditis treatment. antibiotics for 5 major organisms |
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Definition
[image]
• Requires rapid eradication of all microorganisms from the vegetations
• Use bactericidal vs. static agent
• Treat for minimum 4-6 weeks |
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Term
| sbe prophylaxis required for? potential adverse reactions of antibiotics? |
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Definition
• Required for certain high-risk patients and certain invasive procedures
• Potential adverse reactions of antimicrobial agent
– Allergic reactions complicate between 0.7–4.0% of all treatment courses
– Anaphylactic reactions occur between 0.004-0.04%
– Death occurs 0.001%, approximately 300 deaths per year |
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Term
| infective endocarditis prophylaxis indicated vs not indicated chart |
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Definition
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Term
| invasive procedures examples |
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Definition
• Dental procedures
• Tonsillectomy and adenoidectomy
• Surgery involving intestinal or respiratory mucosa
• Surgery on infected soft tissue
• Established GU or other intra-abdominal infections |
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Term
| infective endocarditis prophylactic regimens chart |
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Definition
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