Bacterial Endocarditis- CardioRush

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What are some other terms for bacterial endocarditis?
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Terms in this set (92)
What are some other terms for bacterial endocarditis?
Infective or vegetative endocarditis
What are the 2 locations of bacterial infection on the endocardium?
Valvular, mural
What is more common: valvular endocarditis or mural?
Valvular
What is the incidence of bacterial endocarditis among all reports of CV disease in dogs?
<1%
True or false: bacterial endocarditis is more common in cats than dogs
False (it is even less common in cats than dogs)
True or false: it's thought that bacterial endocarditis is a more common cause of heart disease in horses and ruminants than in small animals
True
What are the general pathologic changes that occur in valvular bacterial endocarditis?
Infection of valves causes proliferation, fibrous valvular changes, vegetative lesions, leading to stenosis or insufficiency
Which is more common as a result of valvular bacterial endocarditis: valvular insufficiency or stenosis?
Insufficiency (occurs in 93% of cases while stenosis only occurs in 7%)
What are the most common causative pathogens in valvular bacterial endocarditis in dogs?
Strep canis, Staph spp. E coli, Bartonella, other gram negatives
What are the most common causative pathogens in valvular bacterial endocarditis in cats?
Step, staph, Bartonella, enteric gram negatives
What are the most common causative pathogens in valvular bacterial endocarditis in horses?Strep equi, Strep zooepidemicus, Actinobacillus equiWhat are the most common causative pathogens in valvular bacterial endocarditis in cattle?Alpha hemolytic strep, Corynebacterium pyogenesWhat is the order in which valves are commonly affected (from most to least common) by valvular bacterial endocarditis in dogs?Mitral, aortic, tricuspid, pulmonicWhat is the order in which valves are commonly affected (from most to least common) by valvular bacterial endocarditis in cats?Aortic and mitral, tricuspid, pulmonicWhat is the order in which valves are commonly affected (from most to least common) by valvular bacterial endocarditis in horses?Mitral and aortic much more common than tricuspid and pulmonicWhat is the order in which valves are commonly affected (from most to least common) by valvular bacterial endocarditis in cattle?Tricuspid, pulmonic, mitral, aorticWhat is the order in which valves are commonly affected (from most to least common) by valvular bacterial endocarditis in swine?Mitral and aortic more common than tricuspid and pulmonicWhat is 1?AortaWhat is 2?Vegetative growth on valveWhat is 3?Normal aortic valve leafletWhat is 4?LVWhat are the 4 factors that have been proposed to contribute to the pathogenesis of subacute bacterial endocarditis?Previously damaged cardiac valve, sterile platelet fibrin thrombus, bacteremia, high titer of agglutinating antibody against the organismTrue or false: the majority of animal that develop subacute bacterial endocarditis have preexisting valve diseaseFalse (the majority don't have an underlying condition of the valve, pathogenesis not completely understood of SBE)True or false: the thrombus formed in subacute bacterial endocarditis is a safe haven for bacterial growth, since poor vascularity of the valve allows it to evade the immune systemTrueWhat are the highly pathogenic bacteria that can adhere to normal valves to cause valvular bacterial endocarditis?Enterococci, Strep, PseudomonasWhat bacteria can produce proteases to induce valve injury and facilitate colonization in the development of valvular bacterial endocarditis?Staph, strepTrue or false: Preexisting valvular pathology is not required for the development of valvular bacterial endocarditisTrueWhat are the factors that predispose dogs to valvular bacterial endocarditis?Preexisting valvular disease esp congenital SAS, immunosuppressive drugs, recent surgery or IV catheter placement, antimicrobial useWhat is the most common signalment for dogs with valvular bacterial endocarditis?Middle aged, male, intact, large breedWhat is a proposed predisposing factor of valvular bacterial endocarditis in horses?AllergyWhat are the possible effects of valvular bacterial endocarditis on the mitral valve?Mitral regurg or stenosis, LCHFWhat are the possible effects of valvular bacterial endocarditis on the aortic valve?Aortic regurg or stenosis, LCHFWhat are the possible effects of valvular bacterial endocarditis on the pulmonic and tricuspid valves?Tricuspid and or pulmonic insufficiency or stenosis, RCHF, PTEWhat are systemic consequences of valvular bacterial endocarditis?Bacteria or thrombi can shed and spreadWhat are some of the potential consequences of bacteria shedding from the valves in valvular bacterial endocarditis?Pyelonephritis, UTI, meningitis, septic arthropathy, myocarditisWhat are some of the potential locations that thrombi can shed valvular bacterial endocarditis, from most to least common?Spleen or kidney, LV, lungs, CNS, GITrue or false: one of the challenging aspects of diagnosing valvular bacterial endocarditis is that other systems can be affected and show primary signs from infection that is based on the heart, making it unclear where the infection startedTrueWhat non-cardiac systems are sometimes affected in valvular bacterial endocarditis, from most to least common?Renal, arthropathy, TE to any organ, liver, spleen, neuro, ATE, lungsWhat can sometimes cause AV block to develop as valvular bacterial endocarditis progresses?Abscess formation around AV ringWhat can sometimes cause ventricular arrhythmias to develop as valvular bacterial endocarditis progresses?Thrombus to coronary vessels and myocardial infarctionWhat are some immunologic effects that can occur in response to a chronic infection such as valvular bacterial endocarditis?Immune mediated polyarthropahy, glomerulonephritis, positive immunologic testsWhich species is more likely to develop CHF as a result of valvular bacterial endocarditis: dogs or cats?CatsIn what percentage of dogs does CHF develop as a result of valvular bacterial endocarditis?30-50%What are some clinical scenarios that may occur as a result of valvular bacterial endocarditis in small animals?CHF, fever of unknown origin, multisystemic signs suggestive of infection or immune disease, organ embolismWhat are some examples of differentials that may be causing fever of unknown origin other than bacterial endocarditis?Neoplasia, diskospondylitisWhat makes bacterial endocarditis easy to mix up with immune mediated disease?Positive Coombs test, multiple organ systems affectedWhat are some common clinical findings in horses associated with valvular bacterial endocarditis?Fever, depression, weight loss, poor BCS (usually nonspecific to cardiac involvement)What is the most common signalment for horses presenting with valvular bacterial endocarditis?Younger, maleWhat are some common clinical findings associated with valvular bacterial endocarditis in cattle?Recurrent fever, dyspnea, epistaxis, weight loss, decreased milk production, tachypnea, tachycardia, anorexiaWhat are the most common changes to CBC that are seen with valvular bacterial endocarditis in cattle?Leukocytosis, neutrophilia, low albumins or globulinsTrue or false: The presenting complaints for valvular bacterial endocarditis are typically specific to the CV systemFalse (usually vague signs, not CV specific)What are some common signs for dogs to present with for valvular bacterial endocarditis?Lethargy, anorexia, and depression most common, sometimes cough, dyspnea, lamenessTrue or false: Myxomatous mitral valve disease in dogs is a predisposing factor for developing valvular bacterial endocarditisFalse (doesn't appear to be a predisposing factor)What is the only congenital heart defect associated with an increased risk of valvular bacterial endocarditis in dogs?SASWhat are the common clinical findings that may occur with presentation of valvular bacterial endocarditis in dogs?Fever, leukocytosis, cardiac murmur, lameness, some combo of these or just oneTrue or false: most dogs present for valvular bacterial endocarditis with a classic combination of signs including fever, leukocytosis, murmur, and lamenessFalse (Often only have one of these, if you look for a combo of them you will miss many cases)What are some cardiac exam findings consistent with valvular bacterial endocarditis in dogs and cats?New or changing murmur, diastolic decrescendo murmur, bounding pulsesWhat type of murmur can occur in horses with both degenerative aortic valvular disease and valvular bacterial endocarditis?Diastolic decrescendo murmurWhat are the more common blood chemistry changes seen in valvular bacterial endocarditis?Hypoalbuminemia, increased ALK, ALT, BUN, or creatineWhat are the CBC changes most commonly seen in valvular bacterial endocarditis?Leukocytosis, neutrophilia (sometimes with left shift or toxic change), monocytosis, thrombocytopeniaWhat are the urinalysis changes that can be seen with valvular bacterial endocarditis?Pyuria, hematuria, proteinuriaWhat are the coagulation test changes that can be seen in valvular bacterial endocarditis?Shortened or prolonged PT, prolonged PTT, high fibrinogenOther than blood panels and urinalysis, what are some additional lab tests that can be used when trying to determine valvular bacterial endocarditis diagnosis?Bartonella serology, immune studies, arthrocentesis, cultureWhat percentage of patients with valvular bacterial endocarditis have an arrhythmia?45%What are some arrhythmias that can develop as a result of valvular bacterial endocarditis?Ventricular, atrial, AV block, ST segment depressionWhat are the characteristics of this ECG from a cat with valvular bacterial endocarditis?Multiform VPCs, AV block, ST segment slurring, prolonged QT intervalWhat are the characteristics of this ECG from a dog with valvular bacterial endocarditis?3rd degree AV block, junctional escapes, ventricular arrhythmiasWhat are the radiographic findings most commonly seen in valvular bacterial endocarditis?Cardiac chamber enlargement, possible CHF or pneumonia, pleural effusion, PTEWhat side of the heart is more likely to be enlarged on radiographs in a dog with valvular bacterial endocarditis?LeftWhat are the radiographic findings?L heart enlargementWhat are the radiographic findings?Cardiomegaly, perihilar and cranioventral alveolar pattern (possible CHF and concurrent pneumonia)What is the appearance of vegetative lesions on the valve on echo in valvular bacterial endocarditis?Thick, asymmetric, shaggy, hyperechoic, oscilating, vibratory, or mobileWhat are some echo findings in the heart that may be seen with a valvular lesion in valvular bacterial endocarditis?Cardiac chamber enlargement or hypertrophy, valvular regurg or stenosisWhat type of echo is best for definition of heart structures and improves diagnostic accuracy in valvular bacterial endocarditis?TransesophagealWhat is the diagnostic accuracy of using echo to find vegetative lesions in valvular bacterial endocarditis?80-90%True or false: this mitral valve is normal in appearanceFalse (thickened, irregular, shaggy, abnormal when in motion)What is 1?Vegetative lesion on aortic valveWhat is needed to establish a definitive diagnosis of bacterial endocarditis?Blood cultureWhat fluid cultures can be supportive in diagnosing valvular bacterial endocarditis if they are showing signs in those systems?Joint, urineWhat is needed to collect an adequate sample for blood culture?Aerobic and anaerobic, sterile prep, obtain 3 sets of cultures 30 min to 1 hour apartWhy are multiple blood culture spaced out needed when diagnosing valvular bacterial endocarditis?Intermittent bacteremia possibleTrue or false: Bartonella typically causes a coinfection with another species when causing valvular bacterial endocarditisFalse (typically lacks a coinfection with other bacteria)What valve is the only one that seems to be affected by Bartonella endocarditis?AorticWhat percentage of canine endocarditis cases were found to be due to Bartonella?20-30%What is included in treatment of valvular bacterial endocarditis?IV broad spectrum abx for 5-14 days or until culture returns, steroids contraindicated (reduced survival with use)What is the combination of antibiotics used for broad spectrum coverage in treatment of valvular bacterial endocarditis?B lactam/cephalosporin with aminoglycoside/fluoroquinoloneWhat antibiotics should be used if Bartonella is thought to be the causative agent in valvular bacterial endocarditis?Doxy and gentamicin/enro in dogs, doxy and pradofloxacin in catsWhat are 2 examples of antibiotics that can be used for additional anaerobic coverage in treatment of valvular bacterial endocarditis?Clindamycin, metronidazoleWhat is the median survival time for dogs with valvular bacterial endocarditis?54 daysWhat are some negative prognostic indicators in valvular bacterial endocarditis in dogs associated with poorer outcome?CHF present, aortic valve affected, gram neg sepsis, renal failure or high creatinine, thrombocytopenia, thromboembolic complications, use of steroids for treatmentWhat are currently the recommendations for prevention of valvular bacterial endocarditis in animals?Use prophylactic abx in high risk patients when undergoing procedure that may cause bacteremiaWhat are some examples of procedures that may induce bacteremia?Dental extractions, prostatectomy, esophageal balloon dilation