infective endocarditis

INFECTIVE ENDOCARDITIS

It is the infection of endocardium, cardiac valves & rarely extracardiac vascular endothelium, more correctly termed as ‘infective endarteritis’

AETIOLOGY
-H A C E K
Haemophilus species
Actinobacillus
Cardiobacterium
Eikinella corrodens
Kingella kingae

Streptococcus viridans (oral cavity)
Streptococcus faecalis (gut)
Staphylococcus aureus

CLINICAL FEATURES
Nails- clubbing, splinter haemorrhages
Fingers – Osler’s nodes
Palm – janeway lesion
Fever
Eyes – subconjunctival haemorrhages
Pallor
Roth spot
Heart – new murmur
Change of preexisting murmur
Loss of peripheral pulses
Evidence of gangrene
Rare – focal neurological deficit

A stroke results from a ischaemic infarction or bleeding into part of the brain, it manifests by rapid onset of focal cns signs and symptoms.
2 types-
Ischeamic stroke-Thromobotic and embolic
Haemorrhagic stroke

Haemorrhagic stroke patients can have history of-
Hypertension,bleeding disorders,any profuse bleeding during surgery,non healing bruises,loss of consciousness,meningeal irritation due to blood in csf,

Haemorrhagic stroke will be dramatic,never slow.something dramatic that will lead to stroke.


Thrombotic Stroke
old age,history of diabetes,hypertension,sedentary lifestyle

Embolic Stroke
Underlying heart problem,underlying vessel problem,diabetes...
In people with Stroke there will be neurological deficiency,no complete recovery.
Dinesh-o41303025

Clinical features of Stroke-people with stroke can have the follwing symptoms

Sudden onset or stepwise progression over hours,contralateral hemiplegia which is initially flacid and later becomes spastic,contralateral sensory loss,homonymous hemianopia,dysphasia,disturbance of gaze and vision,quadriplegia.

Note- stroke usually occurs in the mornings.

Transcient ischaemic attacks- which is a phenomenon where there will be attacks of iscaemia without loss of consciousness,patient recovers.The attacks come in intervals.Complete resolution with in 24 hours

Ee Lik Wee
041303026
Group B3


Acute Stroke
Def: characterised by the rapid appearance(usually over minutes)of a focal deficit of brain function.,most commonly a hemiplegia with or without signs of focal higher cerebral dysfunction,hemisensory loss,visual field defect or brain-stem deficit

Classification of stroke (clinical) :
i)Transient ischaemic attact
-resolve within 24 hrs
ii)Progressing stroke
-focal neurological deficit worsen after the
patient first present
iii)complete stroke
-focal deficit persist and not progressing

D/D of Stroke and TIA:
-Primary cerebral tumours
-metastatic cerebral tumours
-subdural hematoma
-Cerebral abscess
-Hypoglycemia
-Encephalitis
-Focal seizures

Clinical examination of Stroke Pts:
Skin
-xanthelasma
-Rashes(arteritis,splinter h'age)
-Limb ischaemia/DVT

Eyes
-Diabetic changes
-Retina emboli
-HTN changes
-Arcus senilis

CVS
-BP(HTN,hypotension)
-Heart rhythm(AF)
-Murmurs
-JVP
-Peripheral pulses and bruits

RS
-Pulm. oedema
-Resp. infection

Abdomen
-Urinary retention

Locomotor
-Injuries sustained during collapse with stroke
-Comorbidities which influence fucnt. abilities

Differential diagnosis of peripheral edema :

-cardiac failure : right or combined right and left heart failure, pericardial constriction, cardiomyopathy
-chronic venous insufficiency : varicose veins
-hypoalbuminemia : nephritic syndrome, liver disease, protein losing enteropathy (widespread-affects face and arms)
-drugs : Sodium retention-fludcortisone. Increased capillary permeability-Nifedipine, Amlodipine.
-idiopathic
-chronic lymphatic obstruction

JONES Criteria for Diagnosis of Rheumatic Fever :

Major manifestations :
-carditis
-polyarthritis
-chorea
-erythema marginatum
-subcutaneous nodules

Minor manifestations :
-fever
-arthralgia
-raised ESR or CRP
-leucocytosis
-previous rheumatic fever
-first degree AV block

PLUS :
-supporting evidence of preceding streptococcal infection : recent scarlet fever, raised antistreptolysin O or other streptococcal antibody titre, positive throat culture.

Modified Duke Criteria For Diagnosis of Infective Endocarditis :

Major Criteria :
-positive blood culture
*typical organism from two cultures
*persistent positive blood cultures taken >12 hours apart
*three or more positive cultures taken over more than 1 hour
-endocardial involvement
*positive echocardiographic findings of vegetations
*new valvular regurgitation

Minor Criteria :
-predisposing valvular or cardiac abnormality
-intravenous drug misuse
-pyrexia >38 degrees Celcius
-embolic phenomenon
-vasculitic phenomenon
-suggestive echocardiographic findings
-blood cultures suggestive—organism grown but not achieving major criteria

Definitive Endocarditis : 2major or 1major+3minor or 5minor
Possible Endocarditis : 1major+1minor or 3minor


Syndrome of Inappropriate secretion of ADH.
-cause water retention –an endogenous source of ADH (either cerebral or tumour derived) promotes renal water retention in the absence of appropriate physiological stimulus.
-Causes :
*tumors (esp small cell lung ca)
*CNS disorders (stroke, trauma)
*pulmonary disorders (pneumonia, TB)
*drugs (carbamazepine, haloperidol,amitryptiline,chlorpropamide)
*sustained pain,stress,nausea (eg.post op)
*idiopathic


Respiratory Failure :

-Type I
*PaO2 low
*PaCO2 low

-Type II
*PaO2 low
*PaCO2 high