Endocarditis: Difference between revisions
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== | ==Risk Factors== | ||
* IVDA | * IVDA | ||
| Line 29: | Line 29: | ||
** Low Sn, high Sp | ** Low Sn, high Sp | ||
== | ==Diagnosis== | ||
<div> | <div> | ||
* | * Duke Criteria | ||
** 2 major criteria OR | ** 2 major criteria OR | ||
** 1 major and 3 minor criteria OR | ** 1 major and 3 minor criteria OR | ||
| Line 39: | Line 39: | ||
* Major Criteria | * Major Criteria | ||
** Positive blood culture for infective endocarditis | ** Positive blood culture for infective endocarditis | ||
*** S. aureus, S. viridans | *** S. aureus, S. viridans, S. bovis, Enterococci, HACEK | ||
** Evidence of endocardial involvement | ** Evidence of endocardial involvement | ||
*** | *** TEE + or ''new ''valvular regurgitation | ||
* Minor Criteria | * Minor Criteria | ||
** Predisposition - predisposing heart condition or IVDA | ** Predisposition - predisposing heart condition or IVDA | ||
** Fever - 38. | ** Fever - 38.0 C (100.4 F) | ||
** Vascular phenomena | ** Vascular phenomena | ||
*** Arterial emboli, pulmonary infarcts, mycotic aneurysm, ICH, conjunctival hemorrhage, Janeway lesions | *** Arterial emboli, pulmonary infarcts, mycotic aneurysm, ICH, conjunctival hemorrhage, Janeway lesions | ||
** Immunologic phenomena - glomerulonephritis, Osler's nodes, Roth spots, rheumatoid factor | ** Immunologic phenomena - glomerulonephritis, Osler's nodes, Roth spots, rheumatoid factor | ||
** Microbiologic evidence - positive blood culture but not meeting major criterion as noted previously | ** Microbiologic evidence - positive blood culture but not meeting major criterion as noted previously | ||
| Line 53: | Line 53: | ||
</div> | </div> | ||
== | ==Treatment | ||
* Antibiotics | * Antibiotics | ||
Revision as of 17:43, 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
- Recent source of bacteremia?
- 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
- Blood Cx
- 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
- Positive blood culture for infective endocarditis
- 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
- Only bactericidal agents are effective in treating endocarditis
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Complications
- Cardiac
- Heart Failure
- Most common cause of death due to IE
- Perivalvular Abscess
- Heart Failure
- 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