Valvular and congenital heart disease and infective endocarditis
Infective Endocarditis
Source: Paper One. Question Five. MCQs and SBAs in Intensive Care Medicine (Oxford Higher Special Training)
| Flashcard | type:basic |
|---|---|
| What is the most common valve to be affected by Infective Endocarditis? | Aortic Valve |
| In all comers, how likely is your infective endocarditis to be caused by staphlococcal? | 25% |
| In all comers, how likely is your infective endocarditis to be caused by streptococcal? | ~50% |
| In all comers, how likely is your infective endocarditis to be caused by strep viridans? | ~25% |
| In injecting drug users, how likely is your infective endocarditis to be caused by staphylococcal? | ~60% |
| What is the most common bug to cause infective endocarditis (in all comers) | Streptococcal |
| Which is more likely to cause you mortality, IE caused by Strep Viridans or Staph Aureus? | Staph Aureus |
| What is the most common streptococcal bug to cause infective endocarditis? | Strep viridans |
| In infective endocarditis, which population has an increased risk of a staphylococcal IE? | Injecting Drug Users |
| Which is more common side of heart to be affected by infective endocarditis? | Left |
| What are the main patient group more at risk of right sided infective endocarditis? | Injecting drug users |
| What infection is the Duke classification used for? | Infective Endocarditis |
| What is the classification system used for likelihood of infective endocarditis? | Duke |
| What categories can you split the Major Duke criteria for infective endocarditis into? | Blood Cultures Echocardiographic |
| How many major echocardiographic criteria are there for dukes classification for infective endocarditis? | 4 |
| In Dukes Classification how many major criteria do you need to score on to demonstrate Infective Endocarditis (if no minor) | 2 |
| In Dukes Classification how many major and minor criteria do you need to score on to demonstrate Infective Endocarditis | 1 Major + 3 Minor |
| In Dukes Classification how many minor criteria do you need to score on to demonstrate Infective Endocarditis (if no major) | 5 Minor |
| What are the major blood culture criteria in Dukes Classification for IE? | Two Positive Cultures, for organisms usually found in patients with IE |
| What are the four major echo finding criteria in Dukes Classification for IE? | Oscillating Intracardiac Mass, Myocardial Abscess, Dehiscence of Prosthetic Valve, New Valve Regurg |
| In the dukes classification for infective endocarditis is "Predisposing heart condition or intravenous drug use" major or minor? | Minor |
| In the dukes classification for infective endocarditis is "Fever of 38°C (100.4°F) or higher" major or minor? | Minor |
| In the dukes classification for infective endocarditis is "Vascular phenomenon, including major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial haemorrhage, conjunctival haemorrhage, or Janeway lesions" major or minor? | Minor |
| In the dukes classification for infective endocarditis is "Immunologic phenomenon such as glomerulonephritis, Osler nodes, Roth spots, and rheumatoid factor" major or minor? | Minor |
| In the dukes classification for infective endocarditis is "Positive blood culture results not meeting major criteria or serologic evidence of active infection with an organism consistent with IE" major or minor? | Minor |
| In the dukes classification for infective endocarditis is "Echocardiogram results consistent with IE but not meeting major echocardiographic criteria" major or minor? | Minor |
| In the dukes classification for infective endocarditis is "Two blood cultures positive for organisms typically found in patients with IE" major or minor? | Major |
| In the dukes classification for infective endocarditis is "Blood cultures persistently positive for one of these organisms, from cultures drawn more than 12 hours apart" major or minor? | Major |
| In the dukes classification for infective endocarditis is "Three or more separate blood cultures drawn at least 1 hour apart" major or minor? | Major |
| In the dukes classification for infective endocarditis is "An oscillating intracardiac mass on a valve or on supporting structures, in the path of regurgitant jets, or on implanted material, in the absence of an alternative anatomic explanation" major or minor? | Major |
| In the dukes classification for infective endocarditis is "Myocardial abscess" major or minor? | Major |
| In the dukes classification for infective endocarditis is "Development of partial dehiscence of a prosthetic valve" major or minor? | Major |
| In the dukes classification for infective endocarditis is "New-onset valvular regurgitation" major or minor? | Major |
Staphylococcal infections account for approximately 25% of cases of endocarditis, although in the intravenous drug–using community, this can rise to approximately 60%. Most cases of endocarditis are actually caused by Streptococcal infections (50%–70%), with Strep viridans accounting for roughly half of these. IE caused by Staphylococcal infections or fungi have a high associated mortality compared with Streptococci or Enterococci. Most lesions affect the left side of the heart, with right-sided lesions occurring most commonly in patients who inject drugs. The aortic valve is the most commonly affected valve. The Duke Classification is divided into major and minor criteria. IE is demonstrated with either two major, one major and three minor, or five minor criteria. Major blood culture criteria for IE include the following: Two blood cultures positive for organisms typically found in patients with IE Blood cultures persistently positive for one of these organisms, from cultures drawn more than 12 hours apart Three or more separate blood cultures drawn at least 1 hour apart Major echocardiographic criteria include the following: An oscillating intracardiac mass on a valve or on supporting structures, in the path of regurgitant jets, or on implanted material, in the absence of an alternative anatomic explanation Myocardial abscess Development of partial dehiscence of a prosthetic valve New-onset valvular regurgitation Minor criteria for IE include the following: Predisposing heart condition or intravenous drug use Fever of 38°C (100.4°F) or higher Vascular phenomenon, including major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial haemorrhage, conjunctival haemorrhage, or Janeway lesions Immunologic phenomenon such as glomerulonephritis, Osler nodes, Roth spots, and rheumatoid factor Positive blood culture results not meeting major criteria or serologic evidence of active infection with an organism consistent with IE Echocardiogram results consistent with IE but not meeting major echocardiographic criteria Beynon RP, Bahl VK, Prendergast BD. Infective endocarditis. British Medical Journal 2006;333:334–9.