Cardio E1: Endocarditis & Rheumatic Fever

What is the most common valve affected by rheumatic fever?

Mitral valve

ARF follows what type of infection?

Group A strep (GAS)

What is the most common valve affected by rheumatic fever?

Mitral valve

ARF follows what type of infection?

Group A strep (GAS)

What are the Jones major criteria?

CCEPS: Carditis, Chorea, Erythema marginatum, Polyarthritis, SQ nodules

What are the Jones minor criteria?

arthralgias, fever, elevated ESR or CRP, prolonged PR interval, prior hx of ARF

Polyarthritis most affects the ______ joints

Large

Involuntary movements primarily involving the face, tongue, and upper extremity

Chorea

Where is erythema marginatum commonly found?

Trunk and proximal extremities, never on face

Where are the subcutaneous nodules associated with rheumatic fever located?

Extensor tendons of hands and scalp

What is the Jones criteria for acute rheumatic fever?

2 majors (or 1 major 2 minors) and a recent strep infection

What is the most common murmur associated with acute rheumatic fever?

Mitral stenosis

Tx for acute rheumatic fever

Penicillin

Secondary prevention of acute rheumatic fever recurrences

Benzathine Pen G q4wks (up to 10yrs to life)

Tx of acute rheumatic fever for PCN allergy

Cephalosporin or Macrolide (erythro or azithro)

____________ endocarditis is seen in patients with SLE

Libman-Sacks

What is the most common cause of subacute bacterial endocarditis?

Streptococcus viridans

What is the most common valve affected by acute bacterial endocarditis in IVDA?

Tricuspid valve

What is the most common cause of acute bacterial endocarditis in IVDA?

Staph aureus

What are Osler's nodes (seen in IE)?

Small tender nodules on the finger and toes

What are Janeway lesions (seen in IE)?

Small hemorrhages on the palms and soles

What are Roth spots (seen in IE)?

Exudative lesions of the retina

How many blood cultures should be taken for diagnosis of bacterial endocarditis before antibiotics?

3

What is the most sensitive testing done for detecting vegetations associated with bacterial endocarditis?

TEE

According to the Duke criteria, a definite diagnosis of bacterial endocarditis can be made with ___________

- 2 major
- 1 major and 3 minor
- 5 minor

Major Duke criteria

- 2 positive blood cultures
- Echo shows: vegetation, abscess, dehiscence of prosthetic valve

Minor Duke criteria

• predisposing condition

• fever > 38 degrees

• immunologic signs: glomerulonephritis, Osler’s nodes, Roth spots, rheumatoid factor

• 1 positive blood culture

• positive echo not meeting major criteria

Native valve empiric tx NO IVDA

Beta lactam (PCN)+ Aminoglycoside (Gentamicin)

Native valve empiric tx NO IVDA PCN allergy

Vanco + Gentamicin

Native valve empiric tx IVDA

Vanco + Gentamicin

Prosthetic valve Empiric Tx

TRIPLE ABS:
Vanco, Genta, Rifampin

Antibiotic regimen for infective endocarditis treatment is usually _______

4-6 weeks

If IE is unresponsive to tx after 7-10 days what is likely the next step?

surgical valve replacement

Is antibiotic infective endocarditis prophylaxis indicated for patients with AS, MS, or symptomatic/asymptomatic MVP?

No

Is antibiotic infective endocarditis prophylaxis indicated for a GU and GI procedure?

No

Is antibiotic infective endocarditis prophylaxis indicated for dental procedures

Yes

Is antibiotic infective endocarditis prophylaxis indicated for respiratory tract, skin, or MSK tissue procedures?

Yes

What antibiotic is used for prevention of IE during an oral or dental procedure?

Amoxicillin (single dose)

What antibiotic is used for prevention of IE during an oral or dental procedure if PCN allergy?

Clindamycin

Do you give prophylaxis:
Prosthetic cardiac valve

Yes

Do you give prophylaxis:
Previous infective endocarditis

Yes

Do you give prophylaxis:
Congenital heart disease

Yes, but not all

Do you give prophylaxis:
Cardiac transplant patients who develop valvulopathy

Yes

Do you give prophylaxis:
Valve repair without prosthetic materal

No

Do you give prophylaxis:
HOCM

No

Do you give prophylaxis:
MVP with regurgitation or valvular thickening

No

Do you give prophylaxis:
Unrepaired VSD or PDA

No

Do you give prophylaxis:
MS, AR, AS

No

Do you give prophylaxis:
ASD, VSD, PDA that was successfully closed within the past 6 months

No

Do you administer anticoagulation for native valve endocarditis?

No (increased risk of intracerebral hemorrhage)