- 2 major criteria OR
- 1 major and 2 minor criteria OR
- all 5 minor criteria.
- positive blood culture
- typical organism in 2 separate cultures OR
- persistently +blood cultures
- endocardial involvement
- positive echo
- new valvular regurgitation
- fever >38C
- vascular/immunological signs
- predisposition (IVDU, valve replacemen)
- positive blood culture that doesn't mean major criteria
- positive echo that doesn't meet major criteria
Vascular/immunological signs include:
- Janeway lesions
- Oslers nodes
- splinter haemorrhages
- Roth spots
40% of cases of endocarditis occur in patients with no previous problems.
30% have had rheumatic heart disease.
Commonest causative organism is streptococcus viridans (alpha haemolytic)
Commonest organism in IVDUs is staphlycoccus aureus.
Commoenst organism within 6 weeks of valve surgery is staph epidermidis.
Usually bicuspid valve affected, except in IVDUs where the tricuspid valve is most commonly affected.
Mortality from strep in 5%, staph around 30%
Poor prognostic factors:
- s. aureus
- prosthetic valve
- culture negative
- low complement
Treatment:
- initial blind therapy: fluclox and gent
- prosthetic valve/penicillin allergy: vancomycin and rifampicin and gent
- staph: fluclox/vanc and gen
- strep: benzylpenicillin and gent
Surgery if:
- abscess
- recurrent emboli
- severe valve incompetence
- cardiac failure
Random MRCP facts:
- prolongation of PR suggests aortic valve abscess
- if causative organism is found to be strep bovis look for an associated bowel malignancy.
On to upper GI bleeds...
