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Cardiology: Infective Endocarditis - Coggle Diagram
Cardiology: Infective Endocarditis
Microorganisms
Staph
S aureus (most aggressive)
S epidermidis
Coag -ve staph
common in prosthetic valves
Strep
S viridans (subacute, most common)
S sanguis
S mitis
S mutans
S milleri
S bovis (risk of CRC)
Enterococcus faecalis/faecium
A/w lower GI/GU disease + bowel malignancy
Fungi
Candida, aspergillus, histoplasma
in immunocompromised
HACEK group
Haemophilus
Actinobacillus
Cardiobacterium
Einkenella
Kingella
Signs + Sx
Fever
Night sweats
Anorexia + weightloss
myalgia + arthralgia
new murmur
poor dentition
sometimes mild splenomegaly
Oslers nodes + Janeway lesions
Roth spots
Splinter haemorrhages
Risk Factors
IVDU
Surgical procedures
Termination of pregnancy
Age >60
Structural heart disease
Valvular heart disease
Previous IE
haemodialysis
Immunocompromised
Bowel ca
Imaging
ECHO
TTE first, TOE if TTE -ve but still suspicious
TOE 1st if prosthetic valve/ intracardiac device in situ
Cardiac CT if dx unclear
FDG-PET/CT useful in prosthetic valves but must be implanted for 3mo @ least or else can be falsely +ve
Duke's Criteria
Definite IE
2 major criteria
or 1 major 3 minor
or 5 minor
Major
2 separate +ve blood cultures
Imaging evidence
Vegetations
Abcess
Aneurysm
New partial dehiscence of prosthetic valve
Valve perforation
Minor
Microbiology evidence not meeting major criteria
Risk factors present
Vascular phenomena (emboli / thrombosis)
Immunological phenomena (glomerulonephritis, osler nodes)
Fever >38C
Antibiotic Prophylaxis
only recommended in patients with highest risk of IE undergoing highest risk dental procedures
prosthetic valve
prior IE
cyanotic congenital heart disease
Amoxicillin (clindamycin if pen allergic)
Tx
prolonged antimicrobial tx
Follow local guidelines
2-6 wks in native valve, 6+ wks for prosthetic
Surgery
50% will require this
Complications
Heart Failure
Re-infection
Embolism
Stroke
Splenic infarct
AKI
Glomerulonephritis
AV block