0071643192.pdf

■ Conjunctival or splinter hemorrhages

■ Petechiae

■ Immunologic phenomena:

■ Glomerulonephritis

■ Osler’s nodes: Tender nodules on fingertips

■ Roth’s spots: Retinal hemorrhages with central clearing

■ Rheumatoid factor

DIAGNOSIS

■ Presumptive diagnosis based on predisposing condition and presence of fever

■ Duke criteria (see Table 2.16)

TREATMENT

■ Antibiotics: Empiric therapy, awaiting culture results

■ Native valves: Penicillin G +nafcillin +gentamicin

■ Injection drug use: Vancomycin

■ Prosthetic valves: Vancomycin +gentamicin +rifampin

■ Surgical valve repair or replacement as needed

COMPLICATIONS

■ Valvular destruction with resulting CHF

■ Septic emboli and sequelae

■ CNS abscesses, mycotic aneurysm, meningitis

■ Septic pulmonary emboli

■ Paraspinal abscesses

Prophylaxis for Endocarditis

The following populations need antibiotics prior to procedures (*=high-risk

groups):

■ *Prosthetic heart valve

■ *Complex congenital heart disease

■ *Previous bacterial endocarditis

■ Other congenital heart diseases (unrepaired)

CARDIOVASCULAR EMERGENCIES

TABLE 2.16. Duke Criteria for Establishing the Diagnosis of Endocarditis

Major criteria Positive blood cultures ( ≥2 separated by site and time)

Major echo findings (vegetations, abscess, new regurgitation, dehiscence

of prosthetic valve)

Minor criteria Predisposing conditions

Fever

Embolic disease

Immunologic phenomena

Single positive blood culture

Nonmajor echo findings

Diagnosis requires:

Two major criteria or

one major +three minor criteria, or

five minor criteria