Zusammenfassung der Ressource
Flussdiagrammknoten
- CARDIOVASCULAR INFECTIONS
- Infection of the endocardial surfcace
- Damaged / Prosthetic valve
- heart valves are affected most commonly (may also affect septal defects or mural endocardium)
- RISK FACTORS:
Rheumatic heart disease Congenital heart disease Mitral valve prolapse Degenerative valve disease Prosthetic valve
- Flora on Mucus membrane/ other heavily colonized surface
- Dental manipulations Pulmonary, Gastrointestinal, Urological procedures and Tonsillectomy
- FROM - JANE
Fever
Roth's spots
Osler's nodule
Murmur
Janeaway lesions
Anemia
Nail hemorrhage (splinter H)
Emboli
- RISK FACTORS:
Age >60
Male sex
Injection drug use
Poor dentition and dental infection
CO-MORBID CONDITIONS:
Structural heart disease
Valvular disease
Congenital heart disease
Presence of an intravascular device
Chronic hemodialysis
HIV infection
- Staphylococcus aureus:
health-care associated
Acute fulminant endocarditis
Viridans Streptococci:
Community-acquired and seen in older patients
Subacute bacterial endocarditis
- POST-OPERATIVE (PROSTHETIC VALVE)
Early infection: (<2 months)
Staphylococcus aureus,
CoNS, GNBs and Candida (Nosocomial)
Late infection: (>12months)
Viridans Streptococci,
Staphylococcus aureus, CoNS, Enterococci
- Enterococcus species and Streptococcus gallolyticus
associated with colon carcinoma or colonoscopy
- IVDA
Most common is Staphylococcus aureus
Second most common is Pseudomonas aeruginosa
- VIRULENCE FACTORS:
Dextran production
Surface adhesin
Adherence to specific components of NBTE
Glycocalyx and slime layer
- fibronectin and fibrinogen binds to the specific component of NBTE
- septic embolization and deposition of immune complexes:
O, J, R
- MODIFIED DUKE'S CRITERIA
MAJOR and MINOR
- 2 MAJOR
1 MAJOR + 3 MINOR
5 MINOR
- DIAGNOSIS:
Electrocardiogram
Echocardiography
Blood culture (3 samples over 24 hours)
Molecular methods (culture-negative IE)
- Gram positive cocci in chains
Alpha-hemolysis greenish discoloration
NOT lysed by bile
NOT sensitive to optochin
- Enterococcus faecium
Enterococcus faecalis
Gram positive cocci in pairs (spectacle-like)
Carbohydrate antigen - D
No Hemolysis
Grows in 6.5% NaCl
Tolerates 40% bile
Hydrolyze bile esculin
- Gram-positive cocci in clusters
Beta-hemolysis on blood agar
Catalase positive
Coagulase positive
[Coagulase negative - CoNS]
Methicillin sensitivty / resistance
- Non-suppurative complications of Strep pharyngitis
Rheumatogenic strains of Streptococcus pyogenes
Cross-reactivity between antibodies produced and body tissue
Type II Hypersensitivity reactions: Molecular mimicry
Pancarditis - mainly heart valve damage
JONES criteria: Major and Minor
JONES CAFE-PAL
- Infectious agents:
VIRUS:
Coxsackie B virus
Adeno virus
Echo virus
Parvovirus B19
PROTOZOA:
Trypanosoma cruzi
- Acute phase
Subacute phase
Chronic phase
- Contact - droplets from nose and throat
- RISK GROUPS:
Children
age 20-40
longterm steroid and NSAIDS treatment
Alcoholics
Nutritional deficiencies
- DIAGNOSIS:
ECG
Echocardiogram
CMRI
EMB
Elevation of Cardiac enzymes
PCR for viral NA
- CHAGA'S DISEASE:
Trypanosoma cruzi
Reduviid bug (kissing bugs; triatomine bugs)
Amastigote (aflagellate) & Trypomastigote (flagellate)
Chagoma - bite site
Romana's sign - periorbital swelling
- Viral Pericarditis -
Coxsackie A and B
Echovirus, Herpes, Adeno, HIV, Mumps
Purulent pericarditis -
Muliple etiology - Staph. aureus, Strep. pneumoniae, M. tuberculosis
- Echocardiography
ECG: 'saddle-back' concave ST segment elevation and low QRS voltage
ELECTRICAL ALTERNANS
CT & MRI