AM Report 11/08/16 Endocarditis

Risk factors for developing Infective Endocarditis 

-Recent dental/surgical procedure
-Prosthetic valve
-Valvular or congenital heart disease
-IVDU
-Indwelling IV catheter
-Immunosuppression

Signs and Symptoms of Endocarditis

-Fever (90 % of patients!)
-Murmur (85 % of patients)
-Petechiae (20-40 % of patients)
Splinter hemorrhages (~10-15 %)
Splenomegaly
Janeway lesions-Non-tender, erythematous MACULES on palms and soles
Osler nodes- tender, subcutaneous violaceous NODULES, usually on pads of finger and toes
Roth spots– exudative edematous hemorrhages in retina with pale centers

*Remember that peripheral findings are uncommon (<10 %) unless protracted and untreated bacteremia

Indications for surgical repair in endocarditis

-CHF (eg: worsening valvular involvement)
-Perivalvular extension (eg: abscess, development of AV block)
-Systemic embolism
-Prosthetic valve
-CVA
-Persistent sepsis
-Resistant organism (eg: Staph aureus, pseudomonas, fungus)
-Large vegetation (>10-15 mm)

Common organisms implicated in Endocarditis (not an exhaustive list) 

-HACEK organisms (found in oral-pharyngeal region, Haemophilus, Aggregatibacter (previously Actinobacillus), Cardiobacterium, Eikenella, Kingella)
-Staph aureus (most common cause in IVDU)
-Coagulase negative staph
-Strep Gallolyticus (formerly known as Strep Bovis)
-Viridans Strep
-Enterococci

 

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