2666605
| Question | Answer |
| Causes of endocarditis | Bacterial Fungi Q fever (Coxiella burnetti) Legionella Chlamydophila psittaci Bartonella HACEK |
| Indications for surgery in endocarditis | Fistula Abscess Pericarditis Embolic disease persistent fever ventricular failure Aortic valve endocarditis with a conduction disturbance |
| Duke criteria | When a patient has any of the following: - Pathologic evidence of disease - 2 major clinical criteria - 1 major criterion + 3 minor - 5 minor criteria |
| Major clinical criteria for endocarditis | -Positive Blood Cultures -Abnormal echo |
| What makes positive blood cultures count as major criteria | - Must be a typical organism: S. aureus, viridans strep, S. bovis, enterococcus, HACEK; From 2 separate cultures at least 12 hours apart -Any other organism in at least 3 or a majority of >4 cultures from separate sites, all drawn within an hour apart. -Any 1 blood culture that grows C. burnetti or positive serologic test |
| Qualifiers for positive echocardiogram in endocarditis | -Oscillating intracardiac mass visible on valve or valve-supporting structure -Oscillating mass in the path of regurgitant jets -Oscillating mass on implanted intracardiac devices -Abscess -Prosthetic valve dehiscence -New valvular regurgitation |
| Minor clinical criteria in endocarditis | -Predisposing condition (valvular disease or IV drug use) -Fever -Vascular phenomena (emboli, pulm infarct, mycotic aneurysm, stroke, conjunctival hemorrhage, Janeway lesion) -Immunologic phenomena (acute GN, Osler nodes, Roth spots, +RF) -Positive blood culture that does not meet major criterion. |
| Most common cause of cardiac death due to endocarditis | Congestive Heart Failure |
| Most common causes of SBE in children, in order | 1) Viridans streptococci (40%) 2) S. aureus (20-30%) 3) Coag-neg staph 4) Gram neg bacilli 5) Enterococci |
| What is the most likely organism to infect normal heart valves? | Staph aureus |
| Most common cause of IV drug user endocarditis? | S. aureus, usually MRSA Next is enterococci |
| Most common cause of prostheteic valve endocarditis? | S. epidermidis |
| Janeway lesions | Small, nontender macules on palms and soles. Found in Acute Bacterial Endocarditis, NOT Subacute Bacterial endocarditis |
| Roth spots | pale retinal lesions surrounded by hemorrhage |
| Osler nodes | 0.5cm tender nodules on palms, finger tips, and soles. |
| HACEK organisms | Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella - These are often the cause of "culture-negative" endocarditis |
| Treatment of HACEK organisms | PCN + gentamicin or ceftriaxone |
| What is a major concern with endocarditis caused by S. bovis or Clostridium septicus? | Often associated with colon cancer, and therefore a GI work-up is warranted in these patients. |
| Treatment of native valve endocarditis | -For PCN-sensitive streptococcus: 2 weeks PCN G or amp+gent or 4 weeks of PCN/amp, cefazolin, or ceftriaxone. Only use vanc if severe PCN allergy -For PCN-insensitive strep: 4 weeks PCN G or amp+gent x4 weeks -S. aureus endocarditis: oxacillin or cefazolin; if MRSA, vancomycin +/- gent |
| Treatment of prosthetic valve endocarditis | MRSA: vanc + rifampin + gentamicin for 14 days, then vanc + rifampin for 4 weeks S. aureus: nafcillin/oxacillin or cefazolin + gent fo 5 days, then beta-lactam for 6 weeks. |
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