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Infective Endocarditis - Coggle Diagram

- - - - Adheres to valve surface
        
        Thrombus becomes infected (vegetation)
        
        Invasion of valve leaflets
        
        Requires non-infective thrombus
- - - - Within 3 months - 1 yr
    - - Past 1 yr
  - - - As people get older, valves tend to become calcified/stiffer
    - - Congenital
      - Mitral valve prolapse
      - Degenerative
    - - Strep. bovis
        
        Normal colonic flora
        
        If Strep. Bovis in blood cultures, MUST do echocardiogram and colonoscopy
  - - - 40% mortality
      - Can affect previously normal valves
      - Acute clinical course
      - Abscess formation
      - Source
        
        Infected skin lesions
        
        Lung infection
        
        Infected IV line
      - If Staph. aureus in blood cultures, MUST do echocardiogram
    - - Normal mouth flora
        
        Transient bactermia
        
        Chewing
        
        Brushing teeth
        
        Extraction
        
        Scaling
        
        Poor oral hygiene increases risk
      - More subacute presentaiton
      - Usually affects unhealthy vavles
    - - Normal bowel flora
        
        Bloodstream infection usually secondary to GI/GU infection
        
        Need to rule out infective endocarditis when...
        
        No source identified
        
        Persistently positive blood cultures
        
        Patient has valvular lesion
    - - Prosthetic valve
    - - Culture - endocarditis
        
        Other causative organisms
        
        Bartonella
        
        Brucella
        
        Chlamydia
        
        Coxiella
        
        Investigations
        
        Prolonged incubation of cultures
        
        Serology
        
        Histology
        
        Resected valve
        
        PCR
        
        Blood
    - - Healthcare associated
- - - - Heart failure
        
        Due to failed valve
      - Heart block
        
        Mitral valve ---> arrhythmias
      - Paravascular abscess
        
        Extension of bacteria to myocardium
    - - Stroke
      - Ischemia digit/limb
    - - Abscess
        
        Brain
        
        Spleen
      - Septic arthritis
      - Vertebral osteomyelitis
    - - Glomerulonephritis
      - Osler's nodes
      - Roth spots
    - - Acute renal failure
- - - - Dental treatment
      - GI surgery
  - - - Sign of cardiac failure
    - - Janeway lesions
      - Osler's nodes
      - Splinter Haemorrhages
  - - - 3 sets from separate sites over 24 hours
      - If acutely unwell...
        
        2 sets over 1 hour
    - - FBC
      - U&E
      - ESR
        
        Inflammatory marker
      - CRP
    - - Transthoracic echo (TTE)
      - Transesophageal echo (TEE)
  - - - 5 minor criteria
      - 1 major + 3 minor criteria
      - 2 major criteria
    - - 1 major + 1 minor criteria
      - 3 minor criteria
    - - Blood cultures
        
        Typical organism
        
        2 separate blood cultures
        
        Less typical organism
        
        Persistently positive blood cultures
        
        Coxiella burnetti
        
        Single blood culture
        
        Positive serology
      - Echocardiogram
        
        Presence of vegetation
        
        NEW valvular regurgitation
    - - Predisposing heart condition
      - IV drug user
      - Temperature > 38ºC
      - Vascular phenomena
        
        Arterial emboli
        
        Janeway lesions
        
        Septic pulmonary infarcts
      - Immunological phenomena
        
        Glomerulonephritis
        
        Osler's nodes
        
        Roth spots
        
        Rheumatoid factor
- - - - Valve repair/replacement
      - Indications
        
        Heart failure
        
        Prevent embolism
        
        Uncontrolled infection
        
        Over 15mm vegetations
  - - - 4 = native vale
      - 6 = prosthetic valve
    - - Amplicillin + Flucloxacillin + Gentamicin
      - Vancomycin + Gentamicin
        
        For Penicillin allergy
    - - Vancomycin + Gentamicin + Rifampin