17-Infective Endocarditis Year 4 Internal Medicine Notes

17-Infective Endocarditis Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / I MED BEAUTIFUL NOTES / CVS -- Infective Endocarditis Objectives:\n● Understand Infective Endocarditis definition\n● Pathophysiology of endocarditis\n● Diagnostic criteria of infective endocarditis\n● Recognize the risk factors, signs, and symptoms of\ninfectious endocarditis.\n● Anticipate possible complications of infective endocarditis\n● Treatment of endocarditis and appreciation of the necessity\nof rapid treatment.\n● Endocarditis prophylaxis\n\n Done by: Leader: Mohammed Bahatheg Members: Naif Almutari Lamees Alsuwailem\nMubshir Alasmari Haifaa Taleb\n\nRevised by:\nAseel Badukhon\n\nResources:\n436 + 437 slides\n\n Important Notes Golden Notes Extra Book \n\n Overview of Infective Endocarditis (IE) The heart wall composed of three layers which includes:\n\n Innermost layer Endocardium Inflammation (Endocarditis)\n\n Middle Layer Myocardium Inflammation (Myocarditis)\n\n External Layer Pericardium Inflammation (Pericarditis)\n\n Pancarditis is the inflammation of all layers of the heart.\n\n Inflammatory process whatever it is infective or noninfective it can affect any layer\nof the heart.\n\n Heavily influenced by the epidemiology of the infection:\nDeveloped countries; acute illness,\nStaphylococcus aureus, with Developing countries (endemic\nnumerous anatomic sites of RF); Subacute course, viridans\nmetastatic foci of infection and group streptococci.\nworse outcomes.\n\n Infective Endocarditis is an infection of the endocardial surface of the heart, which may include;\none or more heart valves (native or prosthetic), the mural endocardium, a septal defect or an\nintracardiac device.\nThis leads to formation of bulky friable vegetation composed of thrombotic debris and organisms.\nOften associated with destruction of the underlying cardiac tissue. \nInfective endocarditis can\n• IE develops most commonly on affect:\n1- valvular apparatus\nthe mitral valve, closely Heart Septal including chordae tendineae &\nfollowed in descending order of Valves defects\npapillary muscle\n2- endocardium inside\nfrequency by the aortic valve, wherever there is congenital\ncombined mitral & aortic valve, or structural abnormality. Eg\nInteratrial septum defect:\ntricuspid valve & rarely, the It which can create a shunt\npulmonic valve. Affects Interventricular septum\ndefects\n• Mechanical prosthetic & 3- additional structure like\nprostheses; for example if\nbioprosthetic valves exhibit Chordae Arteriovenous patient has VSD closed with\nequal rates of Tendineae\ndacron artificial patch ( not \ninfection.\nShunt animal patch ), this patch\nbecomes part of endocardium\nand can be part of\n• More common in males endocarditis as well. \n\n Pathogenesis of IE Infective endocarditis is the net result of the complex interaction between multiple factors: 1- The bloodstream pathogen. 2- Matrix molecules (fibrin and thrombin) interact with platelets at sites of endocardial cells damage forming VEGETATION which is the hallmark of endocarditis.\n\n 1 Do check the videos \nEndothelial Damage\nCaused by turbulent blood\nflow produced by either a\ncongenital or acquired heart\ndisease. This flow can be \n2\nfrom a high to a low\npressure chamber, high\nvelocity jet, or across a The endothelial\nsurface becomes rough\nnarrowed orifice which\nand it will recruit\ntraumatizes the inflammatory cells (\nendothelium.\nFormation of NBTE WBC and platelets )\ntowards it.\nInflammatory and\nEndothelial damage immunological\ncreates a predisposition for reaction for damage\nforms platelet\ndeposition of platelets and thrombin and fibrin\nfibrin on the surface of the\n3\nplug which we called\nendothelium, which results NBTE.\nin Nonbacterial\nThrombotic Endocarditis\n(NBTE).\nBacterial Adherence\nInvasion of the\nbloodstream with a\nmicrobial species that\nhas the pathogenic\npotential to colonize How 󰇷󰈎󰇶 t󰈊󰈏󰈼 ba󰇹󰉄󰈩r󰇵󰈚i󰈀 ha󰈥󰈦󰈩n?\nthis site\nTrauma to a mucosal surface heavily populated by\n(endocardium). This\nendogenous microflora; Such as the gingiva around the teeth,\nwill result in the\noropharynx, GI Tract, urethra and vagina.\nproliferation of\nThis will releases many different microbial species transiently\nbacteria within NBTE\nforming vegetation into the bloodstream which will leads to transient bacteremia\nthe hallmark of caused by organisms e.g. Viridans group streptococci.\nInfective\nEndocarditis.\nWhat is\nwrong with\nthis crazy\nheart? \n\n Determining Risk (important)\nWell now we know the risk factors, but what does it mean? It means I can now assess the risk of\ninfective endocarditis in patients and according to it proceed with antibiotic prophylaxis based on if\npatient is high risk + the type of procedure they will undergo. Determining the risk depends on: \n1-Presence or absence of a cardiac 2-The type of procedure to be done\ncondition. (mainly deep dental manipulation) You need to know the high risk patients th