Question | Answer |
Risk factors IE | Prosthetic heart valves, stress, cancer, SLE, Dental hygiene, DM, HIV, IVDU, Hemodialysis |
Acute endocarditis timeline | <6 weeks |
Chronic endocarditis | >3 mo |
Clinical findings IE | *fever constitutional, abdo pain, murmur, stroke like symptoms |
Physical exam | Vitals Hands: clubbing, splinter hemorrhages, vasculitic embolic Roth spots, conjunctival hemorrahted JVP Murmurs, rubs, Flui overload |
Eye findings | Roth spot Conjunctival hemorrhages |
Osler's nodes | Painful, erythematous lesions on feet |
Janeway lesions | Painless lesions on palms and soles of feet (from emboli) |
Bugs infecting native valve | Viridans strep Staph aureus HACEK Bartonella Fungal |
HACEK organisms | Hemophilus parainfluenza Actinobacillus Cardiobacterium Eikenella Kingella |
Prosthetic valves | Coagulase negative staph staph aureus GNB, Fungus |
IDVU organisms IVDU | MRSA, pseudomonas, GNB |
Most common valves to get infected | Mitral>aortic>tricuspid>pulmonic |
Criteria to diagnose IE | Duke's criteria (2 major OR 1 major+3 minor OR 5 minor) |
Blood culture of Dukes criteria (major) | blood culture -by bacteria known to cause -3 blood cultures 12 h apart |
Endocardial criteria (major) | Endocardial involvement -echo -valvular regurg |
Minor criteria | -IVDU -Fever -embolization -Janeway, lesions, -GN -Oslers nodes -Roths spots -positive RF -Positive blood culture from bug that doesn't normally cause IE -Echo that doesnt quite meet criteria |
Treatment Acute | abx ASAP to minimize (staph aureus usually) |
Treatment Subacute (4-5mo) | can delay tx until C and S |
Treatment Native valve | Cloxacillin, amp, gent? |
IVDU treatment | Vanco and gent |
Prosthetic valve treatment | Vanco and gent |