High risk patients:
- Prosthetic valves
- High flow heart diseases -> any stenotic valvular lesions, MVP + regurg, PDA (septal defects are not high flow)
- AV fistula
- Indwelling Rt heart cath
- Marfan syndrome
Organisms:
- Native valves (in CHD): viridans
- Prosthetic valves: epidermidis, S. viridans, S. aureus
- IV drug users: aureus, S. epidermidis
- Rarely; enterococci or gram neg (HACEK)
Types:
Duke’s criteria:
2 major OR 1 major + 3 minor OR 5 minor
Management:
- If septic: fluids + pressors (nor-\epinephrine, dopamine)
- Take cultures before initiating abx
- Best first step in dx? Echo
- Do surveillance blood cultures to monitor therapy
Empiric antibiotics:
(combination therapy + IV + usually 6 wks)
- S. viridans:
- Penicillin\amoxicillin\ceftriaxone + gentamicin
- If allergic -> vancomycin + gentamicin
- S. aureus:
- Oxacillin\flucloxacillin\nafcillin + gentamicin
- If allergic -> vancomycin + gentamicin
- If prosthetic valve -> add Rifampin to the above regimen
Endocarditis prophylaxis:
- Who?
- Prosthetic valve
- Previous IE
- Unrepaired cyanotic CHD
- When?
- Only before dental procedures involving manipulation of the gingiva or perforation of the oral mucosa
- Tonsillectomy \ adenoidectomy
- Not recommended for GI, resp, skin procedures!
- How? (30-60 min before procedure)
- Amoxicillin (2gm)
- If allergic -> clindamycin (600mg)
Indications for surgery:
- Refractory CHF
- Persistent sepsis
- Recurrent peripheral emboli
- Perivalvular complication (dehiscence, obstruction, leak)
Download the PDF version: here
References:
- Dr. Alghamdi’s lecture
- Kaplan step 2 lecture notes
- Paul Bolin’s video
