BSC MISC CARDIOVASCULAR ACUTE/SUBACUTE BACTERIAL ENDOCARDITIS

A bacterial infection of the endocardium Duke criteria ◆ Positive blood culture for infective endocarditis (IE) ● Isolation of typical organisms from two positive cultures of blood samples drawn > 12 hours apart, or all of three or a majority of four separate cultures of blood ● Typical organisms include viridans strep, S. bovis, HACEK (H. aphrophilus, A. actinomycetemcomitans, C. hominis, E. corrodens, and K. kingae), or community-acquired S. aureus or enterococci ◆ Endocardial involvement as evidenced by positive echocardiogram for IE defined as… ● Oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation, or ● Abscess, or ● New partial dehiscence of prosthetic valve Frequency of affected valves is aortic > mitral >> tricuspid Vascular phenomena ◆ Major arterial emboli ◆ Septic pulmonary infarcts ◆ Mycotic aneurysm ◆ Intracranial hemorrhage ◆ Conjunctival hemorrhages ◆ Splinter hemorrhages ◆ Janeway lesions Immunologic phenomena ◆ Glomerulonephritis ◆ Osler’s nodes ● Tender fingertip nodules ◆ Roth spots ● Retinal hemorrhages First line treatment is vancomycin ◆ Therapy can be narrowed with blood culture results ANGINA ARRHYTHMIAS PROLONGED QT SYNDROME QTc > 430 msec in men and > 450 msec in women Causes of prolonged QT (QT WIDTH) ◆ QT ● Prolonged QT synd