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Questions and Answers
What percentage of affected persons typically exhibit characteristic peripheral lesions in this condition?
What percentage of affected persons typically exhibit characteristic peripheral lesions in this condition?
Which of the following is NOT considered a characteristic peripheral lesion?
Which of the following is NOT considered a characteristic peripheral lesion?
Which of the following is a minor criterion for diagnosis?
Which of the following is a minor criterion for diagnosis?
What is the minimum number of minor criteria required to support a diagnosis when one major criterion is present?
What is the minimum number of minor criteria required to support a diagnosis when one major criterion is present?
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Which of the following complications is associated with immune complex-mediated responses?
Which of the following complications is associated with immune complex-mediated responses?
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What factor would make the diagnosis of this condition unlikely?
What factor would make the diagnosis of this condition unlikely?
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Which of the following is an example of a vascular lesion?
Which of the following is an example of a vascular lesion?
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What is the minimum accuracy percentage for a definitive diagnosis when the required criteria are met?
What is the minimum accuracy percentage for a definitive diagnosis when the required criteria are met?
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What is a potential complication of untreated infective endocarditis (IE)?
What is a potential complication of untreated infective endocarditis (IE)?
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How long do symptoms generally remain for infections caused by S.aureus without effective treatment?
How long do symptoms generally remain for infections caused by S.aureus without effective treatment?
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What is the typical duration for antimicrobial therapy in the treatment of infective endocarditis?
What is the typical duration for antimicrobial therapy in the treatment of infective endocarditis?
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Which of the following complications can result from embolization of vegetations in infective endocarditis?
Which of the following complications can result from embolization of vegetations in infective endocarditis?
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What is a common treatment approach for drug resistance in infective endocarditis?
What is a common treatment approach for drug resistance in infective endocarditis?
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Which organism is associated with a longer duration of symptomatic infection in infective endocarditis?
Which organism is associated with a longer duration of symptomatic infection in infective endocarditis?
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Which complication is NOT commonly linked to untreated infective endocarditis?
Which complication is NOT commonly linked to untreated infective endocarditis?
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What is the immediate route of administration for antimicrobial agents in infective endocarditis treatment?
What is the immediate route of administration for antimicrobial agents in infective endocarditis treatment?
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What is the most common pathogen responsible for infective endocarditis?
What is the most common pathogen responsible for infective endocarditis?
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Which demographic group is most likely to develop infective endocarditis?
Which demographic group is most likely to develop infective endocarditis?
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What is a characteristic feature of acute infective endocarditis?
What is a characteristic feature of acute infective endocarditis?
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What type of endocarditis is generally considered less serious?
What type of endocarditis is generally considered less serious?
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What is the prevalence of infective endocarditis in the United States?
What is the prevalence of infective endocarditis in the United States?
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Which of the following statements regarding risk factors for infective endocarditis is true?
Which of the following statements regarding risk factors for infective endocarditis is true?
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What are vegetations in the context of infective endocarditis?
What are vegetations in the context of infective endocarditis?
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Which of the following microbes is NOT a common cause of infective endocarditis?
Which of the following microbes is NOT a common cause of infective endocarditis?
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What type of microbes is primarily responsible for subacute infective endocarditis (IE)?
What type of microbes is primarily responsible for subacute infective endocarditis (IE)?
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Which of the following is NOT necessary for the development of IE?
Which of the following is NOT necessary for the development of IE?
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In what scenario might transient bacteremia occur, potentially leading to infective endocarditis?
In what scenario might transient bacteremia occur, potentially leading to infective endocarditis?
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What is the primary composition of vegetations formed in infective endocarditis?
What is the primary composition of vegetations formed in infective endocarditis?
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Which risk factor is most likely associated with nosocomial infective endocarditis?
Which risk factor is most likely associated with nosocomial infective endocarditis?
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Which component of the pathophysiology of infective endocarditis suggests a site for infection during bacteremia?
Which component of the pathophysiology of infective endocarditis suggests a site for infection during bacteremia?
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How do circulating bacteria enhance their likelihood of adherence to endocardial surfaces?
How do circulating bacteria enhance their likelihood of adherence to endocardial surfaces?
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Which of the following conditions is a contributing factor for the formation of blood clots that lead to infective endocarditis?
Which of the following conditions is a contributing factor for the formation of blood clots that lead to infective endocarditis?
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What characteristic allows microorganisms to resist the action of serum complement proteins in infective endocarditis?
What characteristic allows microorganisms to resist the action of serum complement proteins in infective endocarditis?
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Which of the following best describes the bacterial replication time within 6 hours after infection in infective endocarditis?
Which of the following best describes the bacterial replication time within 6 hours after infection in infective endocarditis?
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What happens to microorganisms embedded within vegetations in infective endocarditis?
What happens to microorganisms embedded within vegetations in infective endocarditis?
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What is the typical duration of fever in most patients presenting with infective endocarditis?
What is the typical duration of fever in most patients presenting with infective endocarditis?
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In acute infective endocarditis, how does the fever presentation usually differ from subacute infective endocarditis?
In acute infective endocarditis, how does the fever presentation usually differ from subacute infective endocarditis?
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What role does medical history play in the diagnosis of infective endocarditis?
What role does medical history play in the diagnosis of infective endocarditis?
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What are common systemic signs accompanying low-grade fever in subacute infective endocarditis?
What are common systemic signs accompanying low-grade fever in subacute infective endocarditis?
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Why are microbes deep within vegetations less susceptible to bactericidal antimicrobials?
Why are microbes deep within vegetations less susceptible to bactericidal antimicrobials?
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Study Notes
Infective Endocarditis (IE)
- Life-threatening infection of the endocardium, usually affecting cardiac valves.
- Characterized by microbial colonization (primarily bacteria), leading to vegetations—blood clots with microorganisms and inflammatory cells.
- Common sites include mitral and aortic valves; Staphylococcus aureus is the leading causative agent.
Prevalence
- Occurs in approximately 1–4 cases per 100,000 persons in the U.S.
- No significant changes in incidence over the past 50 years.
- More prevalent in males (2–3 times higher) and people over 50 years old.
- Around 66% of patients have pre-existing structural heart problems.
Causes and Risk Factors
- Various microbes can cause IE, but bacteria are the most frequent (bacterial endocarditis).
- Rapidly progressive acute IE is primarily caused by Staphylococcus aureus, affecting previously healthy hearts.
- Subacute IE commonly arises in those with pre-existing heart conditions, often caused by less virulent organisms like Streptococcus viridans.
- Requires two independent risk factors: damaged endocardium and a portal of entry for microorganisms.
- Potential portals include dental procedures, skin infections, and vascular catheters.
Pathophysiology
- Involves intracardiac vegetations that impact local and systemic functions.
- Abnormal blood flow patterns create sites for infection during bacteremia episodes.
- Vegetations consist of infectious organisms, fibrin, and cellular debris, making them resistant to immune responses.
- Bacterial colonies can replicate within hours, forming aggregates that are nutrient-depleted and less susceptible to treatment.
Diagnosis: Clinical Manifestations and Laboratory Tests
- A detailed medical history is essential, focusing on invasive procedures or drug use prior to symptoms.
- Fever is a common presenting symptom: acute IE presents with rapid, high-grade fever; subacute IE shows low-grade fever with systemic signs.
- Peripheral lesions occur in about 25% of cases, including:
- Petechiae
- Osler nodes
- Splinter hemorrhages
- Janeway lesions
- Roth spots
- Symptoms of pallor and splenomegaly.
- Diagnosis accuracy increases with the presence of two major criteria, one major and three minor criteria, or five minor criteria.
Serious Complications and Prognosis
- Untreated IE can lead to severe complications such as:
- Heart valve damage and resulting heart failure
- Dysrhythmias
- Embolization causing strokes and infections
- Vasculitis and aneurysm formation.
- Most IE cases can be treated effectively with antibiotics; symptoms from other bacteria may resolve quickly, while those from S. aureus may linger longer.
Appropriate Therapy
- Treatment typically involves 4–6 weeks of antimicrobial therapy, starting with IV administration and transitioning to oral.
- Multiple antibiotics may be used simultaneously to enhance efficacy and prevent resistance.
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Description
This quiz explores the key concepts of infective endocarditis, a life-threatening infection affecting the heart's inner lining. It covers definitions, microbial colonization, and the impact on cardiac tissues, including the formation of vegetations. Test your understanding of this critical topic in cardiovascular health.
