Podcast
Questions and Answers
What constitutes a diagnosis of definite Infective Endocarditis (IE)?
What constitutes a diagnosis of definite Infective Endocarditis (IE)?
Which of the following is NOT classified as a minor criterion for Infective Endocarditis?
Which of the following is NOT classified as a minor criterion for Infective Endocarditis?
What is the minimum duration of antibiotic therapy recommended for treating Infective Endocarditis?
What is the minimum duration of antibiotic therapy recommended for treating Infective Endocarditis?
What defines 'rejected Infective Endocarditis'?
What defines 'rejected Infective Endocarditis'?
Signup and view all the answers
Which of the following combinations indicates probable Infective Endocarditis?
Which of the following combinations indicates probable Infective Endocarditis?
Signup and view all the answers
What is the primary classification of infective endocarditis based on?
What is the primary classification of infective endocarditis based on?
Signup and view all the answers
Which organism is most commonly implicated in infective endocarditis?
Which organism is most commonly implicated in infective endocarditis?
Signup and view all the answers
What test is crucial for diagnosing infective endocarditis according to the Modified Dukes criteria?
What test is crucial for diagnosing infective endocarditis according to the Modified Dukes criteria?
Signup and view all the answers
Which of the following is NOT considered a high-risk factor for developing infective endocarditis?
Which of the following is NOT considered a high-risk factor for developing infective endocarditis?
Signup and view all the answers
What clinical feature is most commonly associated with infective endocarditis?
What clinical feature is most commonly associated with infective endocarditis?
Signup and view all the answers
Which of the following findings would be indicative of infective endocarditis in a blood test?
Which of the following findings would be indicative of infective endocarditis in a blood test?
Signup and view all the answers
Which of the following is classified as a major echocardiographic criterion in the diagnosis of infective endocarditis?
Which of the following is classified as a major echocardiographic criterion in the diagnosis of infective endocarditis?
Signup and view all the answers
What type of valve endocarditis occurs in patients with prosthetic valves?
What type of valve endocarditis occurs in patients with prosthetic valves?
Signup and view all the answers
Study Notes
Infective Endocarditis (IE)
- IE is a direct microbial infection of the heart valves, endothelial lining, blood vessels, or congenital anomalies.
- It can be fatal if not treated properly.
- IE is classified as acute or sub-acute based on symptom onset.
- It can also be categorized as native valve endocarditis (NVE) or prosthetic valve endocarditis (PVE) based on the valve affected.
- IE can be caused by various organisms, including bacteria and fungi.
- Incidence of IE is declining due to wider antibiotic access.
Risk Factors
- Risk of IE varies, categorized as low, intermediate, or high.
- Mostly affects diseased valves, but can affect structurally normal valves, particularly in immunocompromised individuals or with virulent organisms.
-
High-risk factors include:
- Previous IE
- Prosthetic valves
- Congenital heart disease (VSD, PDA, COA, BAV)
- Heart transplant
- Intravenous drug abusers (IVDA)
- Long-term indwelling catheters, tunneled neck lines, pacemakers
-
Low-risk factors include:
- Mitral valve prolapse
- Degenerative valve disease
- Rheumatic heart disease
Pathophysiology
- Various organisms can cause IE, but common ones include:
- Streptococcus viridans
- Streptococcus bovis
- Staphylococcus aureus
- Enterococcus faecalis
Clinical Features
- Presents with nonspecific inflammatory and constitutional symptoms like:
- Fever
- Malaise
- Fatigue
- Arthralgia
- Weight loss
- A heart murmur is also common.
Investigations
-
Full blood count / Erythrocyte sedimentation rate:
- Normochromic normocytic anemia, thrombocytopenia, leukocytosis, elevated ESR and CRP.
- Urinalysis: Microscopic hematuria, proteinuria
- Chest X-ray: Features of heart failure, pulmonary septic emboli
- Electrocardiography (ECG): Conduction defect, myocardial infarction
- Blood Cultures: At least 3 separate sets, from different puncture sites taken 1 hour apart.
Diagnosis
- Diagnosis relies on the Modified Dukes criteria.
-
Major criteria:
-
Echocardiography:
- Oscillating intracardiac mass on the valves or supporting structures (vegetation)
- Abscess
- New valvular dehiscence
- New valvular regurgitation
-
Blood culture results:
- Positive blood culture with microbes consistent with IE from 2 separate blood cultures
- Persistently positive blood cultures with microbes consistent with IE from more than 4 blood cultures taken more than 12 hours apart
- All 3 or more of the 4 blood cultures with the 1st and last taken at least more than 1 hour apart
-
Echocardiography:
-
Minor criteria:
- One predisposing structural heart disease or IVDA
- Fever > 38°C
- Vascular phenomena: major arterial emboli, septic pulmonary infarct, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhage, Janeway lesions
- Immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots, rheumatoid factor
- Microbiological evidence: positive blood culture, but not meeting major criteria; serological evidence of active infection with organism consistent with IE
Diagnosis Based on Criteria
- Definite IE: Two major criteria, or one major + 3 minor criteria, or 5 minor criteria.
- Probable IE: One major + 1 minor criteria, or 3 minor criteria.
- Rejected IE: Firm alternative diagnosis for manifestation of endocarditis, or sustained resolution of MOE with antibiotic therapy for 4 days or less.
Treatment
- Multidisciplinary approach involving physician, cardiothoracic surgeon, and bacteriologist.
- Intravenous penicillin and aminoglycoside combination for 4 to 6 weeks.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Explore the critical aspects of Infective Endocarditis (IE), including its classification, risk factors, and causative organisms. This quiz delves into the intricacies of acute and sub-acute forms of IE and emphasizes the importance of timely treatment to prevent fatal outcomes.
