Infective Endocarditis Year 4 Internal Medicine Notes

Infective Endocarditis Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / I MED BEAUTIFUL NOTES / CVS -- ● Objectives:\n● Understand​ ​the​ ​definition​ ​of​ ​Endocarditis\n● Know​ ​the​ ​patho-physiology​ ​of​ ​endocarditis\n● Know​ ​the​ ​presentation​ ​of​ ​patients​ ​with​ ​endocarditis\n● Know​ ​the​ ​treatment​ ​of​ ​endocarditis\n● Know​ ​the​ ​ways​ ​to​ ​prevent​ ​endocarditis ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​[​ ​Color​ ​index​ ​:​ ​ ​Important​ ​ ​ ​ ​Notes​ ​ ​ ​Extra​ ​] \n● Resources:\n● 435​ ​slides\n\n [​ ​ ​ ​ ​Editing​ ​file​ ​ ​ ​ ​ ​ ​ ​ ​ ​Feedback​ ​ ​ ​ ​ ​ ​ ​ ​ ​Share​ ​your​ ​notes​ ​ ​ ​ ​ ​ ​ ​ ​ ​Shared​ ​notes​ ​ ​ ​ ​ ​ ​ ​Twitter​ ​ ​ ​ ​] \n● Done​ ​by​:​ ​ ​Maryam​ ​Saidan​ ​ ​ ​Noura​ ​Al​ ​Kharraz\n● Team​ ​sub-leader:​ ​Mana​ ​Almuhaideb\n● Team​ ​leaders:​ ​Khawla​ ​AlAmmari​ ​&​ ​Fahad​ ​AlAbdullatif\n● Revised​ ​by:​ ​Ahmed​ ​Alyahya​ ​&​ ​Luluh​ ​Alzeghayer \n\n Infective​ ​Endocarditis\n\n ● Review:​ ​The​ ​heart​ ​wall​ ​is​ ​composed​ ​of​ ​three​ ​layers​ ​which​ ​includes:\n1. Innermost​ ​layer:​ ​endocardium​ ​(Inflammation​ ​=​ ​Endocarditis)\n2. Middle​ ​layer:​ ​myocardium​ ​(Inflammation​ ​=​ ​Myocarditis)\n3. External​ ​layer:​ ​epicardium​ ​(Inflammation​ ​=​ ​Pericarditis) \n● Definition:\nInfective​ ​endocarditis​ ​is​ ​an​ ​infection​ ​of​ ​the​ ​endothelial​ ​surface​ ​of​ ​the​ ​heart​ ​in:\n➔ Heart​ ​valves​ ​(usually​ ​involves​ ​cusps​ ​of​ ​valves​ ​ ​&​ ​intracardiac​ ​foreign​ ​bodies,\nsuch​ ​as​ ​prosthetic​ ​valves,​ ​pacemaker​ ​leads​ ​and​ ​surgical​ ​conduits1).\n➔ Septal​ ​defects2\n➔ Chordae​ ​Tendinea\n➔ Arteriovenous​ ​shunt3\n★ Normal​ ​healthy​ ​people​ ​will​ ​never​ ​have​ ​endocarditis,​ ​so​ ​who​ ​will​ ​get​ ​EI?​ ​The​ ​one​ ​who​ ​has​ ​a​ ​problem​ ​in​ ​his​ ​endocardium​ ​like​ ​VHD,​ ​congenital​ ​heart\ndisease​ ​or​ ​having​ ​a​ ​prosthetic​ ​valve.\n★ It​ ​remains​ ​a​ ​life-threatening​ ​disease​ ​with​ ​significant​ ​mortality​ ​(about​ ​20%)​ ​and​ ​morbidity.\n● Pathogenesis:​ ​ ​What​ ​is​ ​the​ ​pathogenesis​ ​of​ ​EI?\n➔ IE​ ​is​ ​the​ ​net​ ​result​ ​of​ ​the​ ​complex​ ​interaction​ ​between​ ​the​ ​bloodstream​ ​pathogen​ ​with​ ​matrix​ ​molecules\nand​ ​platelets​ ​at​ ​sites​ ​of​ ​endocardial​ ​cells​ ​damage​. 1. Endothelial​ ​Damage Caused​ ​by​ ​turbulent​ ​blood​ ​flow​ ​produced​ ​by​ ​either​ ​a​ ​congenital​ ​or​ ​acquired​ ​heart​ ​disease\n(such​ ​as​ ​flow​ ​from​ ​a​ ​high-​ ​to​ ​a​ ​low-pressure​ ​chamber​ ​or​ ​across​ ​a​ ​narrowed​ ​orifice​ ​of​ ​high\nvelocity.​ ​“Valvular​ ​lesions​ ​may​ ​create​ ​non-laminar​ ​flow,​ ​and​ ​jet​ ​lesions​ ​from​ s​ eptal​ ​defects​ ​or​ ​a​ ​patent\nductus​ ​arteriosus​ ​result​ ​in​ ​abnormal​ ​vascular​ ​endothelium”​.​ ​ ​Turbulence​ ​:​ ​High​ ​pressure​ ​ ​ ​Lower​ ​pressure\n ​ ​injury​ ​to​ ​endocardium​ ​(​ ​In​ ​diseased​ ​endocardium,​ ​turbulent​ ​blood​ ​flow​ ​will​ ​lead​ ​to​ ​trauma​ ​to​ ​that\nendocardium​ ​this​ ​trauma​ ​will​ ​create​ ​matrix​ ​molecules​ ​(WBCs,inflammatory​ ​agents,​ ​antigen-antibody​ ​reaction)\nadding​ ​to​ ​it​ ​platelets​ ​ ​ ​they​ ​will​ ​integrate​ ​at​ ​the​ ​site​ ​of​ ​the​ ​trauma​ ​ ​ ​They​ ​will​ ​form​ ​Vegetations​ ​. 2. Formation​ ​of Caused​ ​by​ ​the​ ​deposition​ ​of​ ​platelets​ ​and​ ​fibrin​ ​on​ ​the​ ​surface​ ​of​ ​the​ ​endothelium​ ​which\nNon-Bacterial​ ​Thrombotic was​ ​facilitated​ ​by​ ​the​ ​endothelial​ ​damage.\nEndocarditis​ ​(NBTE) 3. Trauma​ ​to​ ​a​ ​mucosal Such​ ​as​ ​the​ ​gingiva​ ​around​ ​the​ ​teeth,​ ​oro-pharynx​,​ ​GI​ ​Tract,​ ​urethra​ ​and​ ​vagina.\nsurface​ ​heavily​ ​ ​populated Nowadays​ ​ ​it’s​ ​mostly​ ​the​ ​oral​ ​mucosa.​ ​Any​ ​gingival​ ​or​ ​dental​ ​manipulation​ ​leading​ ​to​ ​ ​trauma​ ​of​ ​mucosal\nby​ ​endogenous​ ​microflora surfaces​ ​of​ ​the​ ​mouth​ ​is​ ​a​ ​source​ ​of​ ​IE​ ​(bacteria​ ​enter​ ​the​ ​blood​ ​ ​ ​heart​ ​ ​ ​combine​ ​with​ ​vegetations)​ ​FOR\nPERSON​ ​SUSCEPTIBLE​ ​TO​ ​ENDOCARDIUM​ ​PROBLEMS​ ​(VHD,prosthetic​ ​valve​ ​or​ ​congenital​ ​heart​ ​disease).\n● ​ ​Role​ ​of​ ​GI​ ​Tract,​ ​urethra​ ​and​ ​vagina​ ​in​ ​IE​ ​is​ ​controversial 4. Transient​ ​Bacteremia Bacteraemia​ ​may​ ​arise​ ​for​ ​patient-specific​ ​reasons​ (​ poor​ ​dental​ ​hygiene,​ ​intravenous\ndrug​ ​use,​ ​soft​ ​tissue​ ​infections)​ ​or​ ​may​ ​be​ ​associated​ ​with​ ​diagnostic​ ​or​ ​therapeutic\n\n 1\n​ A​ picoaortic​ ​Conduit​ ​(AAC),​ ​also​ ​known​ ​as​ ​Aortic​ ​Valve​ ​Bypass​ ​(AVB),​ ​is​ ​a​ ​cardiothoracic​ ​surgical​ ​procedure​ ​that​ ​alleviates​ ​symptoms​ ​caused\nby​ ​blood​ ​flow​ ​obstruction​ ​from​ ​the​ ​left​ ​ventricle​ ​of​ ​the​ ​heart.​ ​Picture\n2\n​ ​Heart​ ​septal​ ​defect​ ​refers​ ​to​ ​a​ ​congenital​ ​heart​ ​defect​ ​of​ ​one​ ​of​ ​the​ ​septa​ ​of​ ​the​ ​heart​ ​(Atrial​ ​septal​ ​defect,​ ​Atrioventricular​ ​septal​ ​defect,\nVentricular​ ​septal​ ​defect).\n3\n​ ​An​ ​arteriovenous​ ​fistula​ ​is​ ​an​ ​abnormal​ ​connection​ ​or​ ​passageway​ ​bet