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Cardiovascular Infections - Coggle Diagram

- - - - Staphlycocci
        
        Increasing
        
        S. aureus
        
        Native valves
        
        Acute presentations
        
        Coagulase negative staphylococci
        
        Prosthetic valve endocarditis
      - Streptococci
        
        Decreasing
        
        Viridans Streptococci / α-haemolytic streptococci
        
        S. mitis
        S. Sanguis
        S. oralis (oral flora)
        
        Strep. Gallolyticus (Strep bovis)
        
        Associated with colonic carcinoma
      - Enterococci
    - - HACEK Group
        
        Haemophilus aphrophilus, Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae
        
        Fastidious
        
        REquire prolonged incubation
      - Other GNBs
        
        E.coli
        Klebsiella
        
        Ucommon
      - Pseudomonas aeruginosa
        
        IVDU
    - - Can't be detected by routine culture
        
        Chlamydia
        Q fever
        Brucella
        Legionella
        Mycoplasm
        Bartonella
        
        Diangosis via serology or PCR
      - Fungi
        
        Candida
        Aspergillus
      - No Organism
        
        'Culture negative endocarditis'
        
        May be result of antiobotic therapy prior to cultures being sent
  - - - Recurrent emboli
      - Valve destruction / failure
      - Failure to respond to treatment
      - Difficult to treat organisms
  - - - When?
        
        Dental procedures involved in manipulation of gingival tissue, or perforating the oral mucosa
      - Who?
        
        Previous endocarditis
        
        Prothetic valve
        
        Ventricular assist devices
        
        Cyanotic CHD
        
        Repaired CHD within 6mnth of repair
      - Other Procedures?
        
        No longer recommended fr GI or GU procedures
    - - Consult or ask
      - Check local guidelines
  - - - Accounts of 25% of cases
      - Mechanical valves - higher risk in 1st 3 months
      - Cumalative risk: 5% at 60mnths post-op
      - Onset
        
        2 months of surgery - Early - hospital aquired
        
        12 months - Late onset - community aquired
      - Risk: PV + bacteraemia :10%
      - Risk: PV + candidaemia: 15%
  - - - Often low grade
        Chills
        Rigor
        Nights sweats
    - - New or changing
        +/- other cardiac signs (CCF, chest pain)
    - - Malaise
        Fatigue
        Weight loss
        Arthralgia / myalgia
    - - Arterial emboli (white leg)
        'Stroke'
        Pulmonary infacts (IVDU)
    - - Osler's nodes
        Roth spots
        Janeway lesions
  - - - IVDU
      - Cardiac device infections
      - HIV
      - Congenital heart disease
    - - Sepsis
      - Respiratory symptoms
        Emboli
      - Lung abscess
  - - - 3 sets before starting antibiotics
        At least one hour apart
    - - Of valve if excised
    - - Trans-oesphageal (TOE) superior to trans-thoracic
    - - Eg Q fever
  - - - Microbiology
        
        Typical microorganism from > positive blood cultures without another focus
        
        1 BC if Coxiella sp.
      - Evidence of Endocardial involvement
        
        Echo / Cardiac CT / PET-CT
        
        Vegetation
        
        Abscess
        
        New partial dehiscence of prosthetic valve
    - - Presisposing heart conditions / IVDU
      - Fever >38
      - Vascular phenomena
        
        Arterial embolism
        
        Septic pulmonary infarct
        
        Intracranial haemorrhage
        
        Conjunctival haemorrhages
      - Immunological phenomena
        
        Glomerulonephritis
        
        Osler's nodes
        
        Roth spots
      - Microbiological evidence without fulfilling major criteria
        
        Serology
  - - - Stroke
      - Pulmonary emboli
      - Bowel ischaemia
      - Infarcts of other organs
    - - Elderly px
      - Delayed treatment
      - GNB, fungal, Q fever
      - 1 valve involved
      - Valve destruction
      - CCF
- - - - Coxsackie
      - Influenza
      - Adenovirus
    - - Staphlycocci
      - Streptococci
    - - TB
      - Fungal
      - Parasitic
  - - - NSAIDs
    - - IV antibiotics
      - Pericardial drainage
    - - Rifampicin
        Isoniazid
        Pyrazinamide
        Ethambutol
      - Concurrent steroids
    - - Emergency pericariocentesis
- - - - Coxsackie B
      - Echovirus
      - Influenza
    - - Staph
      - Strep
      - Corynebacterium diphtheriae (unusual in the industrialised world)
      - TB
  - - - Enterovirus PCR of Stool
      - Serology with 4-fold rise in titre
  - - - Advanced cardiac life support
      - Minimal exertion
      - Supportive management
    - - Acute management
      - Secondary prevention
      - Evaluation for cardiac transplant