1 / 23

Student Grand Rounds

Student Grand Rounds. Dr Vermani Firm Ekta, Kavina, Jessica, Rachel, Richard, Siwaporn . Case history. 73 year old retired male PC : presented 1 week ago with fatigue, blackouts and a persistent dry cough that had been present for almost a year

akina
Download Presentation

Student Grand Rounds

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Student Grand Rounds Dr Vermani Firm Ekta, Kavina, Jessica, Rachel, Richard, Siwaporn

  2. Case history • 73 year old retired male • PC: presented 1 week ago with fatigue, blackouts and a persistent dry cough that had been present for almost a year • HPC: 4-month history of increasing fatigue, chest pain, dizziness, generalised weakness, low-grade on and off fever. No history of palpitation, SOB, haematuria. • PMH: Ross procedure (pulmonary autograft), type 1 diabetes • DH: Insulin (Novorapid and Glargine) • SH: no recreational drugs, ex-smoker, drank 35-40 units of alcohol since the age of 16, no history of foreign travel • FM: No relevant family history

  3. Physicalexamination • BP 105/61 mmHg • HR 80/min • RR 18/min • Temp 38.4˚C • Both heart sounds were audible with an additional ejection systolic murmur and a soft early diastolic murmur at the left sternal edge. • Abdomen soft, non-tender • Splenomegaly

  4. Laboratory findings • Renal profile and LFTs were normal • ECG and CXR normal • Echocardiography: moderate aortic AS, mild to moderate AR, large aortic vegetation seen • Blood culture: gram positive cocci • WBC 11.3 • Hb10.5 • Na 134 • K 4.6 • Cl 100 • CRP 120 • ESR 64

  5. Infective Endocarditis

  6. Infective Endocarditis:Definition A microbial infection of the endocardial lining of the heart or heart valve, usually associated with an underlying cardiac defect.

  7. Infective Endocarditis:Aetiology • Bacteria • Staphylococcus aureus • Streptococcus viridans • Staphylococcus epidermidis • Diphtheroids • Streptococcus microaerophilic • Fungi • Candida • Aspergillus • Histoplasma • Others • SLE • Malignancies

  8. Infective Endocarditis:Risk factors • Age • Gender • Congenital heart defects • Cardiac surgery • Organ transplant • Post-op • Pervious endocarditis • Presence of prosthetic valves • IV drug abuse • Valvular dysfunction • Poor dental hygiene

  9. Infective EndocarditisClassification • Acute • Subacute Disease process for both are similar • Bacteraemia • Adherence of organisms • Invasive of valve leaflets

  10. Infective Endocarditis:Pathophysiology • Valves affected: Mitral > aortic > (mitral + aortic) > Pulmonary > Tricuspid • Mechanical and bioprosthetic valves - Equal rates of infection

  11. Infective Endocarditis:Clinical manifestations • Fever • Heart murmur • Non-specific symptoms (weakness, arthralgias, weight loss, night sweats) • Petechiae • Osler’s nodes • Janeway lesions • Splinter haemorrhages • Roth spots • Finger clubbing • Splenomegaly

  12. Infective Endocarditis:Diagnosis – Duke Classification • Major criteria 1. Positive blood culture - Typical organism from 2 cultures – Streptococcus Viridans, Streptococcus bovis, HACEK, S. aureus, Enterococci OR - Persistently positive blood culture OR - Single positive culture for Coxiellaburnetti

  13. Infective Endocarditis:Diagnosis – Duke Classification 2. Evidence of endocardial involvement with positive echocardiogram - Oscillating intracardiac mass OR - Abscess OR - New valve regurgitation

  14. Infective Endocarditis:Diagnosis – Duke Classification • Minor criteria • Predisposing heart condition • Fever > 38˚C • Vascular: emboli, Janeway lesions • Microbiology: positive blood culture but not meeting major • Immunological: Osler’s nodes, Roth spots, glomerulonephritis

  15. Infective Endocarditis:Diagnosis – Duke Classification • Definite IE: - 2 major - 1 major + 3 minor - 5 minor • Possible IE: - 1 major + 1 minor - 3 minor

  16. Infective Endocarditis:Management • Specialisedhospitalisation • Parenteral antibiotics: • Prosthetic valves Vancomycin, Gentamycin, Rifampicin • Native valves Vancomycin, Gentamycin, Ciprofloxacin • Normally 2-6 weeks

  17. Infective Endocarditis:Specific treatments for Staphylococcal IE • 4 weeks IV therapy for native valve endocarditis (NVE), or 6 weeks for prosthetic valve endocarditis (PVE) • NVE: Non-MRSA – Flucloxacillin MRSA – Vancomycin + Rifampicin • PVE: Non-MRSA – Flucloxacillin, Rifampicin + Gentamycin MRSA – Vancomycin, Rifampicin + Gentamycin

  18. Infective Endocarditis:Specific treatments for Streptococcal IE • Standard: Ceftriaxone + Gentamycin • Penicillin allergy: Vancomycin + Gentamycin

  19. Thank you

More Related