all right how are you feeling today hey
guys I'm Rishi decide the chief medical
officer here at all samosas and I want
to talk a little bit about infective
endocarditis today so we're gonna talk
about a few different topics the first
one being signs and symptoms of
endocarditis specifically infective
endocarditis so there's an acronym a
handy acronym to kind of go through this
and it is from chain so just think maybe
you got in a car that is from Jane
although it's not contagious
so from Jane f stands for fevers from R
stands for Roth spots just think of the
eye exam o stands for Osler notes so I
think of ow
Osler al being because of painful or
tender M is murmur so heart murmur
Jane so Jay AME chain is Janeway lesions
and I think I'll just change weight
meaning oh just they're not painful
they're just Janeway lesions so they're
distinct from the also notes which are
al Osler a frenemy a-- and for nail bed
hemorrhages so I'm showing my nails but
nail bed or splinter hemorrhages are
sometimes called
an e fret embolize so sometimes you'll
see embolic phenomenon on CT scan or MRI
or something like that and that's often
evidence again of something cuts kind of
spewing off of your valve and kind of
seating other parts of your body so from
Jane are the signs and symptoms next
let's move down to diagnosis and for
diagnosis you really want to there's
Dukes pressure and many of the things
that I just went over our part of these
criteria specifically minor criteria but
for the major criteria the big things
you want to think about our two blood
cultures an echo so the blood cultures
basically get large volume blood
cultures you see if anything grows out
typically it's gonna be you know
something like staph aureus or staph epi
or Andrew Cox is dr. Cox IED so those
are the most common organisms there are
some very uncommon organisms
that are very uncommon but you should
kind of keep a lookout for yellow
being one of them that often kind of
people will mention because it's tested
using titers but anyway those are the
blood cultures so you see what the lot
grows out the other one being the echo
and the echo is actually kind of
interesting one from my perspective
because I always thought it would be a
vegetation on the valve that you're
looking at and that would be like Oh
endocarditis oftentimes it's something
that's much more subtle so it's like a
change in the way that the valve moves
maybe there's a new regurgitation or
sometimes it's literally just the way
it's moving is a little bit more stiffer
or it's not kind of moving as flexibly
as it was on a prior echo and sometimes
people at prior echoes if they've had
cardiac surgery or something so you can
kind of compare and contrast and say hey
is this valve looking the same as the
previous one so those are the kind of
two keys that you want to look at and
then if it's or if there's a prosthetic
valve dehiscence of the prosthesis is a
classic example of what an accord itis
will do so there's any evidence of
dehiscence then you want to make sure
that you would invest the effort and the
carditis
so those are the keys run diagnosis and
then treatment classically it's going to
be bacterial right so it's gonna be
impaired treatment with antibiotics and
specifically something like unison and
gent or you know if you're thinking
about vancomycin it might be Bank gent
and cipro or sometimes where Fantin is
added on especially around prosthetic
valves so it's gonna be some combination
of those antibiotics and usually this is
just for a few days until you actually
get a culture back and once you see the
culture and the susceptibilities you can
say okay let's just change the
antibiotic regimen accordingly that's
all well and good the key though is the
length of treatment and I say the key
because sometimes you have to treat for
a long time and with prosthetic valves
in particular it's something to do 3 for
a long time it still won't work and
you'll have to get a surgical
replacement done and so just keep in
mind that with prostheses I often think
of prosthesis is being kind of like
plastic in a way and antibiotics don't
treat plastic very well as you can
imagine plastic doesn't blood vessels
phantom products can't get to plastic so
if there's a infection of any prosthetic
material
it's very hard to treat with antibiotics
alone so usually end up having to take
out that valve and and surgically
replacing it so anytime there's
prosthetist it prostheses antibiotics
are usually going to be tried at first
and oftentimes it fails and then you
have to just surgically replace so
that's the keys on treatment and then
one clinical pearl on one I kind of
leave you with is just thinking about
endocarditis as being a biofilm
infection so you think about biofilms is
being bacteria and then there's stuff in
this mucus right so essentially what
happens is antibiotics have a hard time
getting through that mucus to get down
to this bacteria that may be at the
bottom so the key there is just a length
of treatment you end up giving
antibiotics for weeks and weeks as
opposed to let's say a UTI or something
where you give it for maybe three days
or five days with a biofilm infection
usually giving antibiotics for a long
period of time because the way that we
essentially try to counter the fact that
defuses what we're kind of waiting on is
we just let it last for a long time and
over time the concentration of
antibiotic one of the bacteria gets high
enough to where the bacteria will die so
that's why the length of treatment for
endocarditis is so long now is kind of
wondered about that is essentially
because the biofilm infection is what
we're dealing with so anyway I will
leave you with that and I hope that
helped you understand some clinical
aspects of infective endocarditis
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