Cardiology Topic 37: Infective Endocarditis Study Material

predisposing conditions for infective endocarditis

prosthetic valve

congenital heart disease

previous IE

IVDU

cause of IE in the first 60 days from a prosthetic valve

staph epi

cause of IE after 60 days from a prosthetic valve

viridans strep

most common cause of IE in IVDU

staph aureus

most common cause of fungal IE in IVDU

candida

what side of the heart is most commonly involved in IVDU

R heart (bacteria gets in the venous system via IV drugs)

what types of echo are used in diagnosing IE

TTE more specific

TEE more sensitive

most reliable sign of IE

murmur

classic peripheral stigmata of IE

Petechiae

Splinter hemorrhages

Osler nodes

Janeway lesions

Roth spots

petechiae associated with IE are found where

conjunctiva

mouth

upper extremity

splinter hemorrhages

brown streaks under nails (more significant when seen in proximal nail bed)

janeway lesions

painless flat blanching discolorations on palms and soles

osler nodes

small tender nodules usually found on the finger and toe pads

roth spots

retinal hemorrhages with pale center

mycotic aneurysm

result from embolic seeding of vasa vasorum of arteries --> weaken vessel wall leading to dilation and possible rupture

clubbing

in some pts with longstanding disease

modified duke definite IE

2 major

or one major and 3 minor

or 5 minor

modified duke possible IE

1 major and 1 minor

or 3 minor

major modified duke criteria

positive blood culture (from 2 separate cultures)

evidence of endocardial involvement (echo showing oscillating vegetation, abscess, or dehisced prosthetic valve, new valvular regurg)

minor modified duke criteria

fever > 100.4

predisposing condition

osler, roth spotse

complications of IE

Heart failure

conduction disturbances (AV block)

myocardial/valve ring abscess

septic embolism/immune complex deposition

indications for surgical intervention for IE

heart filaure

myocardial/valve ring abscess

persistent bacteremia

recurrent embolic events

large vegetations

prosthetic valve dehiscience

indications for emergency surgery

acute aortic insufficiency with early closure of the mitral valve

rupture of sinus of valsalva into R heart chamber or pericardium

what individuals require antibiotic prophylaxis

prosthetic valves

previous IE

congenital heart disease

cardiac transplant

what procedures require antibiotic prophylaxis in high risk pts

dental procedures

upper resp tract procedures (if incision/biopsy of oral mucosa)

GU or GI (if infections of those systems present)

procedures on infected skin or MSK tissue