Endocarditis: Difference between revisions

(Created page with "==Risk Factors== * IVDA * Most significant risk factor for right-sided disease * Prosthetic heart valve * Structural heart disease * Hemodialysis ==Work-Up== * History * ...")
 
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==<font size="100%">Risk Factors<br /></font>==
* IVDA
** Most significant risk factor for right-sided disease
* Prosthetic heart valve
* Structural heart disease
* Hemodialysis
==Work-Up==
* History
** Recent source of bacteremia?
*** Indwelling catheters, IVDA
* Physical Exam
** Cardiac, fundi, conjunctivae, skin, digits,
* Labs
** Blood Cx
*** All patients with S. aureus bacteremia should be evaluated for IE
** CBC
*** Staphylococcal endocarditis: Leukocytosis +/- thrombocytopenia
*** Subacute endocarditis: WBC may be normal or elevated
** UA
*** C/w glomerulonephritis
* ECG
** Evidence of ischemia, heart block
* CXR
** Septic pulmonary emboli
* TTE
** Low Sn, high Sp
==<font size="100%">Diagnosis</font>==
<div>
* <font size="100%">Duke Criteria</font>
** 2 major criteria OR
** 1 major and 3 minor criteria OR
** 5 minor criteria
* Major Criteria
** Positive blood culture for infective endocarditis
*** S. aureus, S. viridans<font size="100%">, S. bovis, Enterococci, HACEK<br /></font>
** Evidence of endocardial involvement
*** <font size="100%">TEE + or ''new ''valvular regurgitation</font>
* Minor Criteria
** Predisposition - predisposing heart condition or IVDA
** Fever - 38.0�C (100.4�F)
** Vascular phenomena<font size="100%"></font>
*** Arterial emboli, pulmonary infarcts, mycotic aneurysm, ICH, conjunctival hemorrhage, Janeway lesions<font size="100%"></font>
** Immunologic phenomena - glomerulonephritis, Osler's nodes, Roth spots, rheumatoid factor
** Microbiologic evidence - positive blood culture but not meeting major criterion as noted previously
** Echo findings: consistent with IE but do not meet a major criterion as noted above
</div>
==<font size="100%">Treatment</font>==
* Antibiotics
** Only bactericidal agents are effective in treating endocarditis
*** Vancomycin
<div>�</div>
==Complications==
* Cardiac
** Heart Failure
*** Most common cause of death due to IE
** Perivalvular Abscess
* Embolic
** CVA
** Blindness
** Painful, ischemic extremities
** Unusual pain sydromes (due to splenic or renal infarction)
** Hypoxia
** Paralysis
** MI
* Neurologic
** Embolic stroke
** Acute encephalopathy
** Meningoencephalitis
** Purulent or aseptic meningitis
** Cerebral hemorrhage
** Seizure
* Renal
** Infarction
** Glomerulonephritis
* Musculoskeletal
** Vertebral osteomyelitis
==Source==
UpToDate
==Risk Factors==
==Risk Factors==


Revision as of 17:41, 15 March 2011

Risk Factors

  • IVDA
    • Most significant risk factor for right-sided disease
  • Prosthetic heart valve
  • Structural heart disease
  • Hemodialysis

Work-Up

  • History
    • Recent source of bacteremia?
      • Indwelling catheters, IVDA
  • Physical Exam
    • Cardiac, fundi, conjunctivae, skin, digits,
  • Labs
    • Blood Cx
      • All patients with S. aureus bacteremia should be evaluated for IE
    • CBC
      • Staphylococcal endocarditis: Leukocytosis +/- thrombocytopenia
      • Subacute endocarditis: WBC may be normal or elevated
    • UA
      • C/w glomerulonephritis
  • ECG
    • Evidence of ischemia, heart block
  • CXR
    • Septic pulmonary emboli
  • TTE
    • Low Sn, high Sp

Diagnosis

  • Duke Criteria
    • 2 major criteria OR
    • 1 major and 3 minor criteria OR
    • 5 minor criteria
  • Major Criteria
    • Positive blood culture for infective endocarditis
      • S. aureus, S. viridans, S. bovis, Enterococci, HACEK
    • Evidence of endocardial involvement
      • TEE + or new valvular regurgitation
  • Minor Criteria
    • Predisposition - predisposing heart condition or IVDA
    • Fever - 38.0�C (100.4�F)
    • Vascular phenomena
      • Arterial emboli, pulmonary infarcts, mycotic aneurysm, ICH, conjunctival hemorrhage, Janeway lesions
    • Immunologic phenomena - glomerulonephritis, Osler's nodes, Roth spots, rheumatoid factor
    • Microbiologic evidence - positive blood culture but not meeting major criterion as noted previously
    • Echo findings: consistent with IE but do not meet a major criterion as noted above

Treatment

  • Antibiotics
    • Only bactericidal agents are effective in treating endocarditis
      • Vancomycin
�

Complications

  • Cardiac
    • Heart Failure
      • Most common cause of death due to IE
    • Perivalvular Abscess
  • Embolic
    • CVA
    • Blindness
    • Painful, ischemic extremities
    • Unusual pain sydromes (due to splenic or renal infarction)
    • Hypoxia
    • Paralysis
    • MI
  • Neurologic
    • Embolic stroke
    • Acute encephalopathy
    • Meningoencephalitis
    • Purulent or aseptic meningitis
    • Cerebral hemorrhage
    • Seizure
  • Renal
    • Infarction
    • Glomerulonephritis
  • Musculoskeletal
    • Vertebral osteomyelitis

Source

UpToDate

Risk Factors

  • IVDA
  • Most significant risk factor for right-sided disease
  • Prosthetic heart valve
  • Structural heart disease
  • Hemodialysis


Work-Up

  • History
  • Recent source of bacteremia?
  • Indwelling catheters, IVDA
  • Physical Exam
  • Cardiac, fundi, conjunctivae, skin, digits,
  • Labs
  • Blood Cx
  • All patients with S. aureus bacteremia should be evaluated for IE
  • CBC
  • Staphylococcal endocarditis: Leukocytosis +/- thrombocytopenia
  • Subacute endocarditis: WBC may be normal or elevated
  • UA
  • C/w glomerulonephritis
  • ECG
  • Evidence of ischemia, heart block
  • CXR
  • Septic pulmonary emboli
  • TTE
  • Low Sn, high Sp


Diagnosis

  • Duke Criteria
  • 2 major criteria OR
  • 1 major and 3 minor criteria OR
  • 5 minor criteria
  • Major Criteria
  • Positive blood culture for infective endocarditis
  • S. aureus, S. viridans, S. bovis, Enterococci, HACEK
  • Evidence of endocardial involvement
  • TEE + or new valvular regurgitation
  • Minor Criteria
  • Predisposition - predisposing heart condition or IVDA
  • Fever - 38.0°C (100.4°F)
  • Vascular phenomena
  • Arterial emboli, pulmonary infarcts, mycotic aneurysm, ICH, conjunctival hemorrhage, Janeway lesions
  • Immunologic phenomena - glomerulonephritis, Osler's nodes, Roth spots, rheumatoid factor
  • Microbiologic evidence - positive blood culture but not meeting major criterion as noted previously
  • Echo findings: consistent with IE but do not meet a major criterion as noted above
==Treatment==


  • Antibiotics
  • Only bactericidal agents are effective in treating endocarditis
  • Vancomycin
==Complications==


  • Cardiac
  • Heart Failure
  • Most common cause of death due to IE
  • Perivalvular Abscess
  • Embolic
  • CVA
  • Blindness
  • Painful, ischemic extremities
  • Unusual pain sydromes (due to splenic or renal infarction)
  • Hypoxia
  • Paralysis
  • MI
  • Neurologic
  • Embolic stroke
  • Acute encephalopathy
  • Meningoencephalitis
  • Purulent or aseptic meningitis
  • Cerebral hemorrhage
  • Seizure
  • Renal
  • Infarction
  • Glomerulonephritis
  • Musculoskeletal
  • Vertebral osteomyelitis


Source

UpToDate

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