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InfectiveEndocarditi
lecture 21 greenberg
| Question | Answer |
|---|---|
| most common structure involved in infectious endocarditis | the heart valves; thus those with congenital or acquired valvular dz are more at risk for developing IE |
| pathogenesis of infective endocarditis | there is initial damage to endocardium, high blood flow causes accumulation of plts and fibrin. thrombus can trap bacteria, which invade and make more fibrin deposition forming a vegetation, usually at the low-pressure side of an obstruction/valve |
| most common procedures performed by doctors that cause bacteremia | dental extractions, periodontal surg, urethral dilatation, TURP, tonsillectomy |
| how bacteria are able to attach to surfaces/sterile vegetations | viridans Strep, S. bovis and Candida - make dextrans to attach to endocardium // S. aureus binds to fibronectin and fibrinogen |
| most common pathogens of native-valve IE | Staphylococci and Streptococci |
| most common pathogen of IE after GI/GU procedures | Enterococci |
| most common pathogen of IE in IVD user or pt with prosthetic-valve IE | Staphylococci especially MRSA // fungal organisms increasingly associated with IVDA IE |
| cause of most culture-negative IE cases | HACEK organisms (GN & grow slowly) and very rarely Coxiella burnetii |
| _____ lives in gut an if pt develops endocarditis from this pathogen, colon ca is much more highly associated (may be imminent) | Streptococcus bovis |
| IE cases with ______ are associated with alcoholics and homeless persons, almost always when they have prior valvular dz | Bartonella quintana & henselae |
| clinical manifestations of IE | although non-specific, sx are: fever, dyspnea, weakness & chills // PEx findings: fever, murmur that is new or changing in character (especially aortic insufficiency) |
| specific microembolic manifestations of IE | painful Osler nodes, nonpainful Janeway lesions, retinal hemorrhages aka Roth spots, splinter hemorrhages, conj petechiae, CVA |
| cornerstone of IE dx | (+) blood cultures, usually constant level of bacteremia over time |
| which type of Echo is the best at evaluating prosthetic valves? | transesophageal echocardiography |
| tx of IE | avoid anticoagulation, bactericidal abx for 2-8 wks, surg if necessary, manage complications like stroke, arrhythmias, heart blocks, CHF, etc. |
| most common procedures which may merit prophylaxis for IE | bronchoscopy and dental surg |
| cause of most nosocomial bacteremias and thus IE cases | hyperalimentation/TPN & IV cath related infections: IJ = femoral > subclavian, C/L > peripheral lines, AV fistulas for dialysis |
| typical causative agents of myocarditis | most predominantly viral like Echovirus or Coxsackie virus, also Lyme and Chagas dz |
| common causative pathogen for pericarditis | Mycobacterium tuberculosis |
Created by:
sirprakes
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